Staggs, Vincent S; Knight, Jeff E; Dunton, Nancy
Hierarchical Poisson modeling was used to explore hospital and nursing unit characteristics as predictors of the unassisted fall rate. Longitudinal data were collected from 1502 units in 248 US hospitals. The relation between the fall rate and total nurse staffing was positive at lower staffing levels and negative for levels around and above the median. The fall rate was negatively associated with registered nurse skill mix and average registered nurse tenure on the unit.
Schreuders, LIW; Geelhoed, E.; Bremner, A.; Finn, J.; Twigg, D
Introduction: The capacity for a hospital inpatient unit to provide high quality nursing care depends on a complex range of factors. Accurately identifying and measuring these factors is one of the challenges of nursing care quality research. Nursing hours per patient day and skill mix are two quantifiable indicators of capacity to provide nursing care. Aims: The aims of the study are to measure fortnightly, unit-level nurse staffing and compare them to target nurse staffing levels. Method: N...
Staggs, Vincent S; Olds, Danielle M; Cramer, Emily; Shorr, Ronald I
Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units. To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use. We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit's average staffing across study quarters. 3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006-2010. Units had to report at least one quarter with restraint use and one quarter without. We studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention. Nursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3-29 %) and 18 % (95 % CI: 8-29 %) higher for quarters with very low skill mix. In this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.
Rome, Vincent; Harris-Kojetin, Lauren D
This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014. Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level. In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide
Van den Heede, Koen; Simoens, Steven; Diya, Luwis; Lesaffre, Emmanuel; Vleugels, Arthur; Sermeus, Walter
This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.
Harrington, Charlene; Swan, James H
This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.
Staggs, Vincent S.; Dunton, Nancy
Objective To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. Design Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. Settings 8069 nursing units in 1361 U.S. hospitals ...
Choi, JiSun; Staggs, Vincent S
Various staffing measures have been used in examining the relationship between nurse staffing and patient outcomes. Little research has been conducted to compare these measures based on their explanatory power as predictors of nursing-sensitive outcomes. In this study, both administrative and nurse-reported measures were examined. Administrative measures included registered nurse (RN) skill mix and three versions of nursing hours per patient day (HPPD); nurse-reported measures included RN-reported number of assigned patients and RN-perceived staffing adequacy. To examine correlations among six nurse staffing measures and to compare their explanatory power in relation to unit-acquired pressure ulcers (UAPUs). Descriptive, correlational study. 2397 nursing units in 409 U.S. acute care hospitals. Random-intercept logistic regression analyses were performed using 2011 data from a national database. Relationships between nurse staffing measures and UAPU occurrences were examined in eight models, each with one or more staffing measures as predictors. Characteristics of nursing units (RN workgroup education level and RN workgroup unit tenure) and hospitals (size, teaching status, and Magnet status) were included as control variables. Two versions of HPPD (total nursing HPPD and RN HPPD) and RN skill mix were significantly correlated with RN-reported number of assigned patients (r range=-0.87 to -0.75). These staffing measures had weaker correlations with RN-perceived staffing adequacy (r range=0.16 to 0.23). Of the six staffing variables, only RN-perceived staffing adequacy and RN skill mix were significantly associated with UAPU odds, the former being the better predictor. Although RN-perceived staffing adequacy was not highly correlated with administrative measures of HPPD and RN skill mix, it was the strongest predictor of UAPU occurrences. RN-perceived staffing adequacy can serve as a more appropriate measure of staffing for nursing-sensitive outcomes research than
Kash, Bita A; Castle, Nicholas G; Phillips, Charles D
Recent work on nursing home staffing and turnover has stressed the importance of ownership and resources. However, few studies have examined spending behaviors, which might also influence staffing levels and staff turnover rates. This study investigates whether spending behaviors measured by financial ratios are associated with staffing levels and staff turnover in nursing homes. We analyzed cross-sectional data from 1,014 Texas homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the 2003 Area Resource File. First, we examined differences in financial ratios by ownership type. Next, the effect of 10 financial ratios on staffing levels and turnover rates for registered nurses, licensed vocational nurses, and certified nursing assistants was examined using robust regression models. Descriptive data indicated that expense ratios related to resident care activities and staff development were significantly higher among not-for-profit than for-profit homes. Higher profits were associated with lower staffing levels, but not higher turnover rates. Administrative expenses (a measure of management capacity) had a negative impact both on staffing levels and staff turnover for licensed vocational nurses and certified nursing assistants, but they did not affect registered nurse staffing. Employee benefit expenses exhibited a positive impact on registered nurse and licensed vocational nurse staffing levels. The addition of information on financial ratios to models predicting staffing indicators reduced the effect of ownership on these indicators. Solutions to the staffing and turnover problem should focus on more effective management practices. Certain levels of administrative and staff benefit expenses may be necessary to improve professional staff recruitment and reduce both staffing and turnover costs. Differences in these financial ratios may partially explain the role played by ownership in determining staffing levels and turnover.
Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti
This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.
Bowblis, John R
To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. STUDY DESIGN; Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. © Health Research and Educational Trust.
Diya, Luwis; Van den Heede, Koen; Sermeus, Walter; Lesaffre, Emmanuel
The aim of this article was to assess the relationship between (1) in-hospital mortality and/or (2) unplanned readmission to intensive care units or operating theatre and nurse staffing variables. Adverse events are used as surrogates for patient safety in nurse staffing and patient safety research. A single adverse event cannot adequately capture the multi-dimensional attributes of patient safety; hence, there is a need to consider composite measures. Unplanned readmission into the postoperative Intensive Care nursing unit and/or operating Theatre and in-hospital mortality can be viewed as measures that incorporate the effects of several adverse events. We conducted a Bayesian multilevel analysis on a subset of the 2003 Belgian Hospital Discharge and Nursing Minimum Data sets. The sample included 9054 patients who underwent coronary artery bypass surgery or heart valve procedures from 28 Belgian acute hospitals. Two proxies of patient safety were considered, namely postoperative in-hospital mortality in the first postoperative intensive care unit and unplanned readmission into the intensive care and/or operating theatre (including mortality beyond the first postoperative intensive care unit) after the first-operative intensive care nursing unit. There is an association between in-hospital mortality and/or unplanned readmissions and nurse staffing levels, but the relationship is moderated by volume and severity of illness respectively. In addition, the relationship differs between the two endpoints. Higher nurse staffing levels on postoperative general nursing cardiac surgery units protected patients from unplanned readmission to intensive care units or operating theatre and in-hospital mortality. © 2011 Blackwell Publishing Ltd.
Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.
Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819
We used autoregressive latent trajectory (ALT) modeling to examine the relationship between change in nurse staffing and change in medication errors over 6 months in 284 general medical-surgical nursing units. We also investigated the impact of select hospital and nursing unit characteristics on the baseline level and rate of change in medication errors. We found essentially no support for a nurse staffing – medication error relationship either cross-sectionally or longitudinally. Few hospita...
Full Text Available The paper suggests a staffing tool to improve efficiency at a nursing department of a local hospital. The managers consider they are understaffed and try to overwhelm the staffing deficit problem through overtime, rather than hiring additional nurses. The estimates indicate that the shortage at the hospital level corresponds to 300 full time equivalent (FTE nurses. However, the huge amount of allocated budget for overtime becomes a concern since the deficit is not accurately estimated. Indeed, the suggested staffing tool shows that some nursing units are unnecessarily overstaffed. Moreover, the current study reveals that the real deficit is of only 215 FTE resulting in a potential saving of 28%.
Min, Ari; Scott, Linda D
To identify the techniques used to measure nurse staffing and to evaluate the reliability, validity and limitations of nursing hours per patient day (NHPPD). Numerous studies have attempted to identify appropriate nurse staffing levels; however, variations in nurse staffing measures may have caused inconsistent findings regarding the relationships between nurse staffing and quality of care. Seventeen studies using nurse staffing measures were reviewed. Six common nurse staffing measures were identified: nurse-to-patient ratios, full-time equivalents, NHPPD, skill mix, nurse-perceived staffing adequacy and nurse-reported number of assigned patients. Among nurse staffing measures, NHPPD is the most frequently used and is considered to be highly beneficial. This measure shows some evidence of high inter-rater reliability. The predictive validity of NHPPD for patient falls is high, whereas that for pressure ulcers is low. For NHPPD to be applied more effectively as a nurse staffing measure, there is a need for additional reliability testing in various types of units with large sample sizes; further validity research for additional patient outcomes; appropriate adjustments in its application to capture variations in the characteristics of nurses, patients and hospital units; and a consistent data collection procedure. © 2015 John Wiley & Sons Ltd.
Hugonnet, Stéphane; Villaveces, Andrés; Pittet, Didier
The authors compared a case-crossover design, a case-time-control design, and a cohort design to evaluate the effect of nurse staffing level on the risk of nosocomial infections. They evaluated two strategies, conditional logistic regression and generalized estimating equation, to analyze the case-crossover study. The study was performed among critically ill patients in the medical intensive care unit of the University of Geneva Hospitals, Geneva, Switzerland. Of 366 patients who stayed more than 7 days in the intensive care unit between 1999 and 2002, 144 developed an infection. The main reasons for admission were infectious (35.3%), cardiovascular (32.5%), and pulmonary (19.7%) conditions. A comparison of the three study designs showed that lower nurse staffing was associated with an approximately 50% increased risk of nosocomial infections. All analyses yielded similar estimates, except that the point estimate obtained by the conditional logistic regression used in the case-crossover design was biased away from unity; the generalized estimating equation yielded unbiased results and is the most appropriate technique for case-crossover designs. The case-crossover methodology in hospital epidemiology is a promising alternative to traditional approaches, but selection of the referent periods is challenging.
Staggs, Vincent S; Dunton, Nancy
Nursing turnover is expensive and may have adverse effects on patient care. Little is known about turnover's association with most hospital and nursing unit characteristics, including nurse staffing level and registered nurse skill mix. To explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix. Observational cross-sectional study of longitudinal data. 1884 nursing units in 306 U.S. acute care hospitals. During a 2-year period units reported monthly data on staffing and turnover. Total nursing staff turnover and registered nurse turnover rates were modeled as dependent variables in hierarchical Poisson regression models. The following hospital characteristics were considered as predictors: Magnet(®) status, ownership (government or non-government), teaching status, locale (metropolitan, micropolitan, or rural), and size (average daily census). The U.S. state in which the hospital was located was included as a covariate. Unit-level variables included total nursing hours per patient day, size of nursing staff, registered nurse skill mix, population age group (neonatal, pediatric, or adult), and service line (critical care, step-down, medical, surgical, medical/surgical, psychiatric, or rehabilitation). Government ownership, Magnet designation, and higher skill mix were associated with lower total turnover and registered nurse turnover. Neonatal units had lower total and registered nurse turnover than pediatric units, which had lower total and registered nurse turnover than adult units. Unit service line was associated only with total turnover. Psychiatric, critical care, and rehabilitation units had the lowest mean turnover rates, but most differences between service lines were not significant. The other explanatory variables considered were not significant. Several hospital and unit characteristic variables have significant associations with nursing turnover; these associations
van Oostveen, Catharina J; Mathijssen, Elke; Vermeulen, Hester
To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing complexity of healthcare, hospital boards have been implementing NPRs and PCSs. However, many nurses at the unit level believe that staffing levels have become critically low, endangering the quality and safety of their patient care. This descriptive phenomenological qualitative study was conducted in a 1000-bed Dutch university hospital among 24 wards of four specialties (surgery, internal medicine, neurology, gynaecology & obstetrics and paediatric care). Data were collected from September until December 2012. To collect data four focus groups (n=44 nurses) were organized. Additionally, a total of 27 interviews (20 head nurses, 4 nurse directors and 3 quality advisors) were conducted using purposive sampling. The focus groups and interviews were audiotaped, transcribed and subjected to thematic analysis. Nurse staffing issues appear to be merely the 'tip of the iceberg'. Below the surface three underlying main themes became clear - nursing behaviour, authority, and autonomy - which are linked by one overall theme: nurses' position. In general, nurses' behaviour, way of thinking, decision-making and communication of thoughts or information differs from other healthcare disciplines, e.g. physicians and quality advisors. This results in a perceived and actual lack of authority and autonomy. This in turn hinders them to plead for adequate nurse staffing in order to achieve the common goal of safe and high-quality patient care. Nurses desired a valid nursing care intensity system as an interdisciplinary and objective communication tool that makes nursing care visible and creates possibilities for better positioning of nurses in hospitals and further professionalization in
Nadolski, Charles; Britt, Pheraby; Ramos, Leah C
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
Kash, Bita A.; Castle, Nicholas G.; Naufal, George S.; Hawes, Catherine
Purpose: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. Design and Methods: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost…
Cho, Eunhee; Lee, Nam-Ju; Kim, Eun-Young; Kim, Sinhye; Lee, Kyongeun; Park, Kwang-Ok; Sung, Young Hee
The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. A cross-sectional survey. A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care
Zinn, J S
This study examines the extent to which nursing homes adjust staffing and care practices relative to local market conditions. Weighted two-stage least squares regression results suggest that facilities employ more nonprofessional nursing staff in markets in which professional nurse wages are higher. RN staffing levels are higher in markets with a higher percentage of self-pay nursing home residents and a lower percentage of for-profit nursing homes. Controlling for resident characteristics, the use of labor-saving practices is higher in markets with higher average nursing home wages, suggesting that there are economic incentives to hire fewer nursing personnel.
Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses
Oppel, Eva-Maria; Young, Gary J
To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility. The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. An observational research design was used entailing a pooled, cross-sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix-percentage of registered nurses; staffing flexibility-percentage of part-time nurses). All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns. © Health Research and Educational Trust.
Veranth, Martha M; Cheson, Christine
A computerized system developed at LDS Hospital in Salt Lake City, Utah for staffing and scheduling PRN nursing personnel is described. Pre- and post-implementation staffing and scheduling activities are compared.
Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H
To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.
Li, Xiaocong; Bowman, Stephen M; Smith, Tyler C
The ramifications of inadequate nurse staffing may have serious consequences due to reimbursement policies. To determine the effects of registered nurse staffing on hospital-acquired conditions in cardiac surgery patients. Data from the 2009 to 2011 Nationwide Inpatient Sample were used to construct a propensity score-matched cohort. Multivariate regressions were performed to compare the probability, length of stay, mortality, and costs of three common hospital-acquired conditions between low- and high-staffing hospitals. A total of 439,365 patients in low-staffing hospitals were 1:1 matched to patients in high-staffing hospitals. High-staffing hospitals had 10% to 25% fewer cases (adjusted odds ratio [AOR] 0.75-0.90, p < .0001), 5% to 20% lower mortality (AOR 0.80-0.95, p < .0001), and 4% to 6% shorter length of stay (coefficient -0.06 to -0.04, p < .0001). The costs for patients with hospital-acquired conditions were 13% to 17% greater in high-staffing hospitals (coefficient 0.13-0.17, p < .0001). Alternatives to the current staffing and reimbursement policies should be considered to reduce hospital-acquired conditions. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Althaus, J N; Hardyck, N M; Pierce, P B; Rodgers, M S
It must be emphasized that none of the steps described in this planning process emerged overnight. Rather, they were achieved through a process of evolution, sometimes through trial and error, and always with consultation and participation by many members of the hospital nursing staff. Participation by many in the process of planning for a workable staffing system has been essential to its success. Indeed, creative scheduling by the head nurse is possible because of the way in which the system has been organized. The fact that head nurses are responsible for staffing their own units makes it infinitely easier for them to see what they need to make their units operate effectively and efficiently. Creative scheduling includes the possibility of arranging nurses' hours outside the rigid three-shift schedule used by so many hospitals. Many El Camino nurses now report for work at different hours. In addition, the use of flexible work weeks has proven valuable. Some head nurses now allow for a ten-hour, four-day work week; in emergency staffing situations there have, on occasion, been twelve-hour days. Even as this system evolves, it faces change. Just as the requirements for staff cannot be rigid, so must problem solving be flexible and constantly under review. The fact that El Camino believes in constant monitoring of its system is essential to its success. A key philosophical foundation of decentralization is that it must be subject to change. This is no less true in staffing than in other parts of the decentralization structure. By agreeing that change is constant and necessary and that participation is required at all levels of the staffing planning process, we have constructed the outlines of a system that will work in the future as well as it does in the present. Our system centers around the head nurses. It involves their planning; thus it also involves the support of those members of the nursing staff who can provide essential information. But the decisions
Mark, Barbara; Harless, David W; Spetz, Joanne
In 2004, California became the first state to implement minimum-nurse-staffing ratios in acute care hospitals. We examined the wages of registered nurses (RNs) before and after the legislation was enacted. Using four data sets-the National Sample Survey of Registered Nurses, the Current Population Survey, the National Compensation Survey, and the Occupational Employment Statistics Survey-we found that from 2000 through 2006, RNs in California metropolitan areas experienced real wage growth as much as twelve percentage points higher than the growth in the wages of nurses employed in metropolitan areas outside of California.
Sasso, Loredana; Bagnasco, Annamaria; Petralia, Paolo; Scelsi, Silvia; Zanini, Milko; Catania, Gianluca; Aleo, Giuseppe; Dasso, Nicoletta; Rossi, Silvia; Watson, Roger; Sermeus, Walter; Icardi, Giancarlo; Aiken, Linda H
Some authors argue that it is not longer ethically correct to expose hospitalized patients to death risks associated with understaffing (Nickitas, 2014). Also the Care Quality Commission (CQC, an independent regulator of all health and social care services in England) has included staffing levels as one of the auditing quality standards when inspecting hospitals and health centres. The Royal College of Nursing, in its document Mandatory Nurse Staffing Levels (RCN, 2012), clearly defined which nurse staffing levels should be adopted by policy makers to ensure the provision of safe care. However, even in the UK where such pressure exists there are no legally defined nurse staffing levels. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
North, Nicola; Leung, William; Ashton, Toni; Rasmussen, Erling; Hughes, Frances; Finlayson, Mary
To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers. © 2012 Blackwell Publishing Ltd.
Kortbeek, N.; Braaksma, A.; Burger, C.A.J.; Bakker, P.J.M.; Boucherie, R.J.
Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method t
Kortbeek, N.; Braaksma, A.; Burger, C.A.J.; Bakker, P.J.M.; Boucherie, R.J.
Workloads in nursing wards depend highly on patient arrivals and lengths of stay, both of which are inherently variable. Predicting these workloads and staffing nurses accordingly are essential for guaranteeing quality of care in a cost-effective manner. This paper introduces a stochastic method tha
Rogowski, Jeannette A; Staiger, Douglas O; Patrick, Thelma E; Horbar, Jeffrey D; Kenny, Michael J; Lake, Eileen T
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009-2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting. © 2015 Wiley Periodicals, Inc.
Full Text Available The purpose of this literature review is to explore the relationship between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality through a consideration of what is meant by perceptions of nursing care quality. Different people define nursing care quality in many ways. It is complex, multi-faceted and multi-dimensional, and attempts to assess, monitor, evaluate and improve nursing care quality have evolved over a number of years. Of particular interest is the way in which changes in nurse staffing, nurse job satisfaction, nurse practice environment, and burnout may affect the quality of nursing care delivery. A search was conducted using the CINAHL, Medline and Embase databases, HINARI, Science Direct, Google, and PubMed. The terms searched included quality of health care; nursing care quality; nurse job satisfaction; nurse practice environment; burnout; and nurse staffing. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. Quality of care is a complex, multi-dimensional concept, which presents researchers with a challenge when attempting to evaluate it. Many different tools have assessed nursing care quality. In addition, the review found that there were relationships between nurse staffing, nurse job satisfaction, nurse practice environment, burnout, and nursing care quality. [Int J Res Med Sci 2015; 3(8.000: 1825-1831
Glance Laurent G
Full Text Available Abstract Background The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. Methods We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1 mortality, (2 healthcare associated infections (HAI, and (3 failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region. Results A 1% increase in the ratio of licensed practical nurse (LPN to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001 and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p Conclusions Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers.
Tyler, Denise A.; Feng, Zhanlian; Leland, Natalie E.; Gozalo, Pedro; Intrator, Orna; Mor, Vincent
Objective The objective of this study was to document the growth of postacute care and contemporaneous staffing trends in US nursing homes over the decade 2001 to 2010. Design We integrated data from all US nursing homes longitudinally to track annual changes in the levels of postacute care intensity, therapy staffing and direct-care staffing separately for freestanding and hospital-based facilities. Setting All Medicare/Medicaid-certified nursing homes from 2001 to 2010 based on the Online Survey Certification and Reporting System database merged with facility-level case mix measures aggregated from resident-level information from the Minimum Data Set and Medicare Part A claims. Measurements We created a number of aggregate case mix measures to approximate the intensity of postacute care per facility per year, including the proportion of SNF-covered person days, number of admissions per bed, and average RUG-based case mix index. We also created measures of average hours per resident day for physical and occupational therapists, PT/OT assistants, PT/OT aides, and direct-care nursing staff. Results In freestanding nursing homes, all postacute care intensity measures increased considerably each year throughout the study period. In contrast, in hospital-based facilities, all but one of these measures decreased. Similarly, therapy staffing has risen substantially in freestanding homes but declined in hospital-based facilities. Postacute care case mix acuity appeared to correlate reasonably well with therapy staffing levels in both types of facilities. Conclusion There has been a marked and steady shift toward postacute care in the nursing home industry in the past decade, primarily in freestanding facilities, accompanied by increased therapy staffing. PMID:23810390
Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol
This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
Kim, Hongsoo; Harrington, Charlene; Greene, William H.
Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…
Full Text Available Background: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority.Objective: This study sought to establish the amount of time that clinical nurse practitioners (CNPs in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care.Methods: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified.Results: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs.Conclusions: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified – task shifting and adjustments in health workerd eployment – as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.
Martsolf, Grant R; Gibson, Teresa B; Benevent, Richele; Jiang, H Joanna; Stocks, Carol; Ehrlich, Emily D; Kandrack, Ryan; Auerbach, David I
To study the association between hospital nurse staffing and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. State hospital financial and utilization reports, Healthcare Cost and Utilization Project State Inpatient Databases, HCAHPS survey, and American Hospital Association Annual Survey of Hospitals. Retrospective study using cross-sectional and longitudinal models to estimate the effect of nurse staffing levels and skill mix on seven HCAHPS measures. Hospital-level data measuring nurse staffing, patient experience, and hospital characteristics from 2009 to 2011 for 341 hospitals (977 hospital years) in California, Maryland, and Nevada. Nurse staffing level (i.e., number of licensed practical nurses and registered nurses per 1,000 inpatient days) was significantly and positively associated with all seven HCAHPS measures in cross-sectional models and three of seven measures in longitudinal models. Nursing skill mix (i.e., percentage of all staff who are registered nurses) was significantly and negatively associated with scores on one measure in cross-sectional models and none in longitudinal models. After controlling for unobserved hospital characteristics, the positive influences of increased nurse staffing levels and skill mix were relatively small in size and limited to a few measures of patients' inpatient experience. © Health Research and Educational Trust.
杨雪莹; 许翠萍; 李云峰; 褚梁梁; 罗云; 刘凯; 葛洪霞
目的 确立无陪护模式病房护理人员能级框架及各级护理人员准入与能力标准,实现护士能级对应.方法 采用Delphi法对28名护理专家进行3轮函询.结果 3轮咨询专家权威程度均值分别为0.779、0.801、0.818;第3轮专家意见协调系数为0.187～0.320(均P＜0.05);确定出无陪护模式病房护理人员为助理护士、注册护士Ⅰ级、注册护士Ⅱ级、专科护士、临床护理专家5个能级框架及各级护理人员准入与能力标准.结论 专家积极性较高,权威性、协调性较好,确立的无陪护模式病房护理人员能级框架及其准入与能力标准可试行应用.%Objective To construct a nursing staffing levels classification framework for nurses working in only-nurse attending wards, and to establish qualifications and detailed requirements. Methods Twenty eight nursing experts were consulted by using a three-round Delphi process. Results The authority degree of the experts were 0. 779, 0. 801, and 0. 818 respectively; the coordination coefficients ranged from 0. 187 to 0. 320 at the third round (P<0. 05 for all). Nurses working in only-nurse attending wards were classified into five staffing levels: nurse assistants, junior registered nurses, senior registered nurses, specialized nurses, and clinical nurse specialists; qualifications and detailed requirements of each level were formulated. Conclusion This staffing levels classification system for nurses working in only-nurse attending wards can be applied to practice, which can be confirmed from experts' attentive involvement, their authority degree and the consent rating degree of their views.
Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook
The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.
Shurberg, D.A.; Haber, S.B. [Brookhaven National Lab., Upton, NY (United States); Morisseau, D. [Nuclear Regulatory Commission, Washington, DC (United States)] [and others
The objective of this project is to provide a technical basis for the establishment of criteria for minimum staffing levels of licensed and non-licensed NPP shift personnel. Minimum staffing levels for the purpose of this study, are defined as those necessary for successful accomplishment of all safety and additional functions that must be performed in order for the licensee to meet applicable regulatory requirements. This project involves a multi-faceted approach to the investigation of the issue. Relevant NRC documentation was identified and reviewed. Using the information obtained from this documentation review, a test plan was developed to aid in the collection of further information regarding the adequacy of current shift staffing levels. The test plan addresses three different activities to be conducted to provide information to the NRC for use in the assessment of current minimum staffing levels. The first activity is collection of data related to industry shift staffing practices through site visits to seven nuclear power plants. The second activity is a simulator study, which will use licensed operator crews responding to a simulated event, under two different staffing levels. Finally, workload models will be constructed for both licensed and non-licensed personnel, using a priori knowledge of the simulator scenarios with data resulting from one of the staffing levels studied in the simulator, and the data collected from the site visits. The model will then be validated against the data obtained from the second staffing level studied in the simulator. The validated model can then be used to study the impact of changing staffing-related variables on the plant shift crew`s ability to effectively mitigate an event.
Bloom, J R; Alexander, J A; Nuchols, B A
The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.
Park, Claire Su-Yeon
To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.
Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René
Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically
Staffing in hospitals has a history of being based in opinion and tradition, not evidence. In recent years, for many, staffing practices have spun out of control creating chaos in overtime, the use of incentives, entitlement behaviors, dissatisfaction and frustration among nurses, and has opened doors for such things as staffing ratio legislation. Unprecedented pressures around budgets and financial performance have no doubt compounded this situation. We are in a new day, where technology can help us more than ever in a move towards staffing excellence and staffing practices based on evidence. Highly successful implementations of new technologies are the result of good leadership. The effectiveness of staffing and scheduling has significant business, safety, and quality implications that sit at the heart of the nurse executive's role.
Shang, Jingjing; Stone, Patricia; Larson, Elaine
Researchers have been studying hospital nurse staffing in relation to health care-associated infections (HAIs) for >2 decades, and the results have been mixed. We summarized published research examining these issues, critically analyzed the commonly used approaches, identified methodologic challenges, proposed potential solutions, and suggested the possible benefits of applying an electronic health record (EHR) system. A scoping review was conducted using MEDLINE and CINAHL from 1990 onward. Original research studies examining relationships between nurse staffing and HAIs in the hospital setting and published in peer-reviewed English-language journals were selected. A total of 125 articles and abstracts were identified, and 45 met inclusion criteria. Findings from these studies were mixed. The methodologic challenges identified included database selection, variable measurement, methods to link the nurse staffing and HAI data, and temporality. Administrative staffing data were often not precise or specific. The most common method to link staffing and HAI data did not assess the temporal relationship. We proposed using daily staffing information 2-4 days prior to HAI onset linked to individual patient HAI data. To assess the relationships between nurse staffing and HAIs, methodologic decisions are necessary based on what data are available and feasible to obtain. National efforts to promote an EHR may offer solutions for future studies by providing more comprehensive data on HAIs and nurse staffing. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
McNair, Douglas S
In balancing competing priorities, it is essential that nursing staffing provide enough nurses to safely and effectively care for the patients. Mathematical models to predict optimal "safety stocks" have been routine in supply chain management for many years but have up to now not been applied in nursing workforce management. There are various aspects that exhibit similarities between the 2 disciplines, such as an evolving demand forecast according to acuity and the fact that provisioning "stock" to meet demand in a future period has nonzero variable lead time. Under assumptions about the forecasts (eg, the demand process is well fit as an autoregressive process) and about the labor supply process (≥1 shifts' lead time), we show that safety stock over lead time for such systems is effectively equivalent to the corresponding well-studied problem for systems with stationary demand bounds and base stock policies. Hence, we can apply existing models from supply chain analytics to find the optimal safety levels of nurse staffing. We use a case study with real data to demonstrate that there are significant benefits from the inclusion of the forecast process when determining the optimal safety stocks.
Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum.
Bray, Kate; Wren, Ian; Baldwin, Andrea; St Ledger, Una; Gibson, Vanessa; Goodman, Sheila; Walsh, Dominic
Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In-flight Forum. The aim of this paper is to provide an overview of the much more detailed document 'Standards for Nurse Staffing in Critical Care', which can be found on the BACCN web site at www.baccn.org.uk. The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In-flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support
Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P
Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an increased likelihood of frequent occurrences of dialysis hypotension, skipped dialysis treatments, shortened dialysis treatments, and patient complaints in hemodialysis units. These findings indicate that federal, state, and dialysis organization policies must foster staffing structures and processes of care in dialysis units that effectively utilize the invaluable skills and services of professional, registered nurses.
Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development.
Griffiths, Peter; Ball, Jane; Drennan, Jonathan; Dall'Ora, Chiara; Jones, Jeremy; Maruotti, Antonello; Pope, Catherine; Recio Saucedo, Alejandra; Simon, Michael
A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence, which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the National Institute for Health and Care Excellence guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing
Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine
Objective To solicit input from registered nurse members of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Design Thematic analysis of responses to a cross-sectional on-line survey question: “Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units.” Participants N = 884 AWHONN members. Main Outcome Measure Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Results Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Conclusion Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. PMID:22690743
Simmons, S F; Osterweil, D; Schnelle, J F
Recommendations have been made to increase the number of nursing home (NH) staff available to provide feeding assistance during mealtime. There are, however, no specific data related to two critical variables necessary to estimate mealtime staffing needs: (1) How many residents are responsive to feeding assistance? (2) How much staff time is required to provide feeding assistance to these residents? The purpose of this study was to collect preliminary data relevant to these two issues. Seventy-four residents in three NHs received a 2-day, or six-meal, trial of one-on-one feeding assistance. Total percentage (0% to 100%) of food and fluid consumed during mealtime was estimated across 3 days during usual NH care and 2 days during the intervention. The amount of time that staff spent providing assistance and type of assistance (i.e., frequency of verbal and physical prompts) was measured under each condition. One half (50%) of the participants significantly increased their oral food and fluid intake during mealtime. The intervention required significantly more staff time to implement (average of 38 minutes per resident/meal vs 9 minutes rendered by NH staff). The time required to implement the feeding assistance intervention greatly exceeded the time the nursing staff spent assisting residents in usual mealtime care conditions. These data suggest that it will almost certainly be necessary to both increase staffing levels and to organize staff better to produce higher quality feeding assistance during mealtimes.
Full Text Available 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.
Liljamo, Pia; Lavander, Päivi; Kejonen, Pirjo
The Oulu University Hospital's staffing management project sought information on the number of nursing staff in relation to treatment days and visits, using existing indicators to describe the activities involved. The retrospective data obtained was compared to human resources and the personnel structure. On this basis an optimal number of staff was determined for the units, taking account of a range of explanatory indicator data. The project made use of the computational model for nurse staffing and the World Health Organisation's (WHO) Workload Indicators of Staffing Need (WISN) method. The project provided extensive information on human resources issues within the units. Its results indicated the differences between wards with respect to the number and structure of resources. In addition, the nurse administrators lacked skills in gathering and using data from administrative datasets. This information will provide support for the further development of nursing operations and nursing management decision-making.
Zhang, Ning Jackie; Gammonley, Denise; Paek, Seung Chun; Frahm, Kathryn
Using 2003 Online Survey Certification and Reporting (OSCAR) data for Medicare and Medicaid certified facilities (N=14, 184) and multinomial logistic regression this study investigated if (1) psychosocial care quality was better in facilities where State requirements for qualified social services staffing exceeded Federal minimum regulations and (2) facility service environments are associated with psychosocial care quality. For-profit status and higher percentage of Medicaid residents are associated with lower quality. Staffing, market demand, and market competition are associated with better quality. Psychosocial care quality is more associated with payer status and market forces and less with regulatory requirements. PMID:19361113
McHugh, Matthew D; Kelly, Lesly A; Sloane, Douglas M; Aiken, Linda H
When California passed a law in 1999 establishing minimum nurse-to-patient staffing ratios for hospitals, it was feared that hospitals might respond by disproportionately hiring lower-skill licensed vocational nurses. This article examines nurse staffing ratios for California hospitals for the period 1997-2008. It compares staffing levels to those in similar hospitals in the United States. We found that California's mandate did not reduce the nurse workforce skill level as feared. Instead, California hospitals on average followed the trend of hospitals nationally by increasing their nursing skill mix, and they primarily used more highly skilled registered nurses to meet the staffing mandate. In addition, we found that the staffing mandate resulted in roughly an additional half-hour of nursing per adjusted patient day beyond what would have been expected in the absence of the policy. Policy makers in other states can look to California's experience when considering similar approaches to improving patient care.
Rantz, Marilyn J; Hicks, Lanis; Petroski, Gregory F; Madsen, Richard W; Alexander, Greg; Galambos, Colleen; Conn, Vicki; Scott-Cawiezell, Jill; Zwygart-Stauffacher, Mary; Greenwald, Leslie
There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
Van den Heede, Koen; Lesaffre, Emmanuel; Diya, Luwis; Vleugels, Arthur; Clarke, Sean P.; Aiken, Linda H.; Sermeus, Walter
Background In most multicenter studies that examine the relationship between nurse staffing and patient safety, nurse-staffing levels are measured per hospital. This can obscure relationships between staffing and outcomes at the unit level and lead to invalid inferences. Objective In the present study, we examined the association between nurse-staffing levels in nursing units that treat postoperative cardiac surgery patients and the in-hospital mortality of these patients. Design-setting-participants We illustrated our approach by using administrative databases (Year 2003) representing all Belgian cardiac centers (n = 28), which included data from 58 intensive care and 75 general nursing units and 9054 patients. Methods We used multilevel logistic regression models and controlled for differences in patient characteristics, nursing care intensity, and cardiac procedural volume. Results Increased nurse staffing in postoperative general nursing units was significantly associated with decreased mortality. Nurse staffing in postoperative intensive care units was not significantly associated with in-hospital mortality possibly due to lack of variation in ICU staffing across hospitals. Conclusion This study, together with the international body of evidence, suggests that nurse staffing is one of several variables influencing patient safety. These findings further suggest the need to study the impact of nurse-staffing levels on in-hospital mortality using nursing-unit-level specific data. PMID:19201407
Van den Heede, Koen; Lesaffre, Emmanuel; Diya, Luwis; Vleugels, Arthur; Clarke, Sean P; Aiken, Linda H; Sermeus, Walter
In most multicenter studies that examine the relationship between nurse staffing and patient safety, nurse-staffing levels are measured per hospital. This can obscure relationships between staffing and outcomes at the unit level and lead to invalid inferences. In the present study, we examined the association between nurse-staffing levels in nursing units that treat postoperative cardiac surgery patients and the in-hospital mortality of these patients. DESIGN-SETTING-PARTICIPANTS: We illustrated our approach by using administrative databases (Year 2003) representing all Belgian cardiac centers (n=28), which included data from 58 intensive care and 75 general nursing units and 9054 patients. We used multilevel logistic regression models and controlled for differences in patient characteristics, nursing care intensity, and cardiac procedural volume. Increased nurse staffing in postoperative general nursing units was significantly associated with decreased mortality. Nurse staffing in postoperative intensive care units was not significantly associated with in-hospital mortality possibly due to lack of variation in ICU staffing across hospitals. This study, together with the international body of evidence, suggests that nurse staffing is one of several variables influencing patient safety. These findings further suggest the need to study the impact of nurse-staffing levels on in-hospital mortality using nursing-unit-level specific data.
Full Text Available Objective verify the application of the Workload Indicators of Staffing Need method in the prediction of nursing human resources at a Family Health service. Method descriptive and quantitative study, undertaken at a Family Health service in the city of São Paulo. The set of sequential operations recommended in the Workload Indicators of Staffing Need method was used: definition of the professional category, type of health service and calculation of Available Work Time; definition of workload components; identification of mean time for workload components; dimensioning of staff needs based on the method, application and interpretation of the data. Result the workload proposed in the Workload Indicators of Staffing Need method to nursing technicians/auxiliary nurses was balanced with the number of professionals available at the Family Health service. The Workload Indicators of Staffing Need index amounted to 0.6 for nurses and 1.0 for nursing technicians/auxiliary nurses. Conclusion the application of the Workload Indicators of Staffing Need method was relevant to identify the components of the nursing professionals' workload. Therefore, it is recommendable as a nursing staffing tool at Family Health services, contributing to the access and universal health coverage.
Roberts, Amy Restorick; Bowblis, John R
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.
Yin, Huahua; He, Haiyan; Arbon, Paul; Zhu, Jingci; Tan, Jing; Zhang, Limei
To explore: the selection criteria for first responder nurses during disaster; scope of practice for disaster relief nurses; appropriate nurse - medical practitioner ratio at the disaster site. Nurses are key members of disaster response medical teams. A scarcity of literature exists relating to nurses attending disasters, their qualifications, experience, scope of practice and appropriate staffing ratios. Qualitative and quantitative data were collected via survey using self-developed questionnaires. Participants were 95 medical workers, who participated in emergency rescue teams following the 2008 Wenchuan earthquake in China. A response rate of 93·7% achieved. The questionnaire included questions relating to nurses: previous experience in disaster relief; scope of practice at the disaster site; optimal ratio of medical practitioners to nurses in disaster relief teams. Following a disaster, first responder nurses considered most suitable were those with at least three years clinical experience, particularly in the emergency department or having emergency rescue skills training. The scope of practice for disaster relief nurses was different to that of nurses working in a hospital. The majority of participants reported insufficient nurses during the relief effort, concluding the optimal ratio of medical practitioner to nurse should range between 1:1-1:2 depending on the task and situation. At the scene of disaster, the preferred first responder nurses were nurses: with emergency rescue training; experienced in the emergency department; with at least three years clinical experience. The scope of practice for first responder nurses needs to be extended. Appropriate nurse - medical practitioner ratios in responding medical teams is dependant on the specific medical requirements of the disaster. The recommendations made by this study provide a guide to ensure that nurses can contribute effectively as essential members of first responder emergency disaster relief teams
Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.
Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943
Lerner, Nancy B
The objective of this data analysis was to explore whether nurse staffing levels and skill mix influenced the number and severity of nursing home deficiencies in Maryland nursing homes. Nursing staff levels and skill mix in relation to quality outcomes in nursing homes have been explored with inconsistent results. Two multiple regression analyses were done to explore factors influencing deficiencies and the severity of the deficiencies found during the annual survey process. The factors influencing the number of deficiencies were the number of nursing home beds (β = .29), nursing assistant hours per patient-day (β = -.206), and the location of the nursing home (β = -.138). The only factor influencing the severity of the deficiencies was RN hours per patient-day (β = -.199). In conclusion, it was determined that RN staffing, although not associated with the number of deficiencies, is associated with deficiency severity.
McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl
This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.
especiai ly critica , on 59 units with thirty or forty patients. On the other hand, ciassification by a charge nurse relieves the staff nurses of...han . a w lirmum 73 costs less, but increases the potential of a staffing crisis if census rises sharply in a short period of time. To arrive a: a
Beltempo, Marc; Blais, Régis; Lacroix, Guy; Cabot, Michèle; Piedboeuf, Bruno
Objective This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05-2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47-1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67-1.99, Q4 vs. Q1). Conclusion Nursing overtime is associated with higher odds of HCAI in the NICU. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
MS, Suzie Aparicio; Welch Bacon, Cailee E.; Parsons, John T.; Bay, R. Curtis; Cohen, Randy P.; DeZeeuw, Terry; McLeod, Tamara C. Valovich
Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their
Pruinelli, Lisiane; Delaney, Connie W; Garciannie, Amy; Caspers, Barbara; Westra, Bonnie L
There is a growing body of evidence of the relationship of nurse staffing to patient, nurse, and financial outcomes. With the advent of big data science and developing big data analytics in nursing, data science with the reuse of big data is emerging as a timely and cost-effective approach to demonstrate nursing value. The Nursing Management Minimum Date Set (NMMDS) provides standard administrative data elements, definitions, and codes to measure the context where care is delivered and, consequently, the value of nursing. The integration of the NMMDS elements in the current health system provides evidence for nursing leaders to measure and manage decisions, leading to better patient, staffing, and financial outcomes. It also enables the reuse of data for clinical scholarship and research.
Full Text Available Abstract Background Little is known about the effects of professional staffing on cancer surgical outcomes. The present study aimed to investigate the association between cancer surgical outcomes and physician/nurse staffing in relation to hospital volume. Methods We analyzed 131,394 patients undergoing lung lobectomy, esophagectomy, gastrectomy, colorectal surgery, hepatectomy or pancreatectomy for cancer between July and December, 2007–2008, using the Japanese Diagnosis Procedure Combination database linked to the Survey of Medical Institutions data. Physician-to-bed ratio (PBR and nurse-to-bed ratio (NBR were determined for each hospital. Hospital volume was categorized into low, medium and high for each of six cancer surgeries. Failure to rescue (FTR was defined as a proportion of inhospital deaths among those with postoperative complications. Multi-level logistic regression analysis was performed to examine the association between physician/nurse staffing and FTR, adjusting for patient characteristics and hospital volume. Results Overall inhospital mortality was 1.8%, postoperative complication rate was 15.2%, and FTR rate was 11.9%. After adjustment for hospital volume, FTR rate in the group with high PBR (≥19.7 physicians per 100 beds and high NBR (≥77.0 nurses per 100 beds was significantly lower than that in the group with low PBR ( Conclusions Well-staffed hospitals confer a benefit for cancer surgical patients regarding reduced FTR, irrespective of hospital volume. These results suggest that consolidation of surgical centers linked with migration of medical professionals may improve the quality of cancer surgical management.
Rogowski, Jeannette A.; Staiger, Douglas O.; Patrick, Thelma E; Jeffrey D Horbar; Kenny, Michael J.; Lake, Eileen T.
The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that deter...
Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile
The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B
To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.Journal of Perinatology advance online publication, 21 September 2017; doi:10.1038/jp.2017.146.
Full Text Available To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe.Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS, taking into account specific workload fluctuations (50th-95th percentiles.Patients classified to the MTS category red (n = 35 required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118, nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181, 40.95 min, while the two MTS categories with the least acute patients, green (n = 129 and blue (n = 40 required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010 emergency patients, 67-123 emergency patients (50-95% percentile per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1.Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.
Belletti, S; Dutreix, A; Garavaglia, G; Gfirtner, H; Haywood, J; Jessen, K A; Lamm, I L; Mijnheer, B; Noël, A; Nüsslin, F; Rosenow, U; Schneider, P; Seelentag, W; Sheriff, S; Svensson, H; Thwaites, D
The safe application of ionising radiation for diagnosis and therapy requires a high level of knowledge of the underlying processes and of quality assurance. Sophisticated modern equipment can be used effectively for complicated diagnostic and therapeutic techniques only with adequate physics support. In the light of recent analyses and recommendations by national and international societies a joint working group of representatives from ESTRO (European Society for Therapeutic Radiology and Oncology) and from EFOMP (European Federation of Organisations for Medical Physics) was set up to assess the necessary staffing levels for physics support to radiotherapy. The method used to assess the staffing levels, the resulting recommendations and examples of their practical application are described.
Maas, Meridean L; Specht, Janet P; Buckwalter, Kathleen C; Gittler, Josephine; Bechen, Kate
Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nation's most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized.
Tabatabaee, Seyed Saeed; Vafaee-Najar, Ali; Amiresmaili, Mohammad Reza; Nekoie-Moghadam, Mahmood
Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model. We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15. The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses' efficiency, and being a native. Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran.
Tabatabaee, Seyed Saeed; Vafaee-Najar, Ali; Amiresmaili, Mohammad Reza; Nekoie-Moghadam, Mahmood
Background: Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model. Methods: We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15. Results: The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses’ efficiency, and being a native. Conclusions: Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran. PMID:28348723
Aiken, L.H.; Sloane, D.M.; Bruyneel, L.; Heede, K. Van den; Griffiths, P.; Busse, R.; Diomidous, M.; Kinnunen, J.; Kozka, M.; Lesaffre, E.; McHugh, M.D.; Moreno-Casbas, M.T.; Rafferty, A.M.; Schwendimann, R.; Scott, P.A.; Tishelman, C.; Achterberg, T. van; Sermeus, W.
BACKGROUND: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether
Aiken, L.H.; Sloane, D.M.; Bruyneel, L.; Heede, K. Van den; Griffiths, P.; Busse, R.; Diomidous, M.; Kinnunen, J.; Kozka, M.; Lesaffre, E.; McHugh, M.D.; Moreno-Casbas, M.T.; Rafferty, A.M.; Schwendimann, R.; Scott, P.A.; Tishelman, C.; Achterberg, T. van; Sermeus, W.
BACKGROUND: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether diff
some 40 pieces of patient classification literature, and in 1976 it was likely that the number had tripled (Giovannetti, 1979). Today the literature...generally require a second nurse initially and are detained for observation or admitted. Examples include: acute asthma, COPD ; threatened, incomplete, or
Combes, Jean-Baptiste; Delattre, Eric; Elliott, Bob; Skåtun, Diane
Spatial wage theory suggests that employers in different regions may offer different pay rates to reflect local amenities and cost of living. Higher wages may be required to compensate for a less pleasant environment or a higher cost of living. If wages in a competing sector within an area are less flexible and therefore less competitive this may lead to an inability to employ staff. This paper considers the market for nursing staff in France where there is general regulation of wages and public hospitals compete for staff with the private hospital and non-hospital sectors. We consider two types of nursing staff, registered and assistant nurses and first establish the degree of spatial variation in the competitiveness of pay of nurses in public hospitals. We then consider whether these spatial variations are associated with variation in the employment of nursing staff. We find that despite regulation of pay in the public and private sector, there are substantial local variations in the competitiveness of nurses' pay. We find evidence that the spatial variations in the competitiveness of pay are associated with relative numbers of assistant nurses but not registered nurses. While we find the influence of the competitiveness of pay is small, it suggests that nonpay conditions may be an important factor in adjusting the labour market as might be expected in such a regulated market.
Hill, Karen S; Higdon, Karen; Porter, Bernard W; Rutland, Michael D; Vela, Donna K
Nurse leaders have struggled for generations with using the right staff in appropriate roles and numbers to optimally cover patient care services and yet preserve salary dollars when possible. The Baptist Health system identified opportunities to enhance communication across facilities and encouraged executives and department leaders to work together to achieve common goals of efficiency and quality. Baptist Health created an operations and efficiency council with representation from each of the seven hospitals in the system, as well as corporate leaders and support staff. Beginning in April 2014, the system began consistently exceeding productivity targets and effectively eliminated a $30 million dollar salary variance from the spring of 2013.
Simons, Kelsey; Connolly, Robert P; Bonifas, Robin; Allen, Priscilla D; Bailey, Kathleen; Downes, Deirdre; Galambos, Colleen
The Minimum Data Set 3.0 has introduced a higher set of expectations for assessment of residents' psychosocial needs, including new interviewing requirements, new measures of depression and resident choice, and new discharge screening procedures. Social service staff are primary providers of psychosocial assessment and care in nursing homes; yet, research demonstrates that many do not possess the minimum qualifications, as specified in federal regulations, to effectively provide these services given the clinical complexity of this client population. Likewise, social service caseloads generally exceed manageable levels. This article addresses the need for enhanced training and support of social service and interdisciplinary staff in long term care facilities in light of the new Minimum Data Set 3.0 assessment procedures as well as new survey and certification guidelines emphasizing quality of life. A set of recommendations will be made with regard to training, appropriate role functions within the context of interdisciplinary care, and needs for more realistic staffing ratios. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
The availability of technology to monitor and manage data increases our ability to better understand the processes and outcomes needed for patient care. It is important to remember this work requires not only the science of data management, but also the art of integrating the multiple variables involved in the dynamic of safe staffing. Fasoli and Haddock (2010) provided an excellent summary of the literature. Nurse leaders must be open to new additions to this work and the possibility that the essential ingredient of the gold standard for patient classification systems (PCS) might still be missing. The goal of a new approach to determine time for nurse work was to advance the science of PCS from the perspective of the characteristics identified by Fasoli and Haddock.
Ball, Jane E.; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter
Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursi...
Stombaugh, Angie; Judd, Andrea
The purpose of this study was to explore nursing student's confidence level with basic nursing care when entering the nursing program after implementation of required nursing assistant certification for program admission. In addition, the relationship between being employed as a nursing assistant and confidence level with basic nursing care when entering the nursing program was explored. A Likert-scale survey assessing confidence levels of basic nursing care was sent to 156 nursing students admitted to a nursing program prior to their first nursing course. Confidence level with nursing skills, nursing assistant employment, and length of nursing assistant employment were assessed. Students were most confident in hand washing (M = 5.87, SD = 0.36), gloving and gowning (M =5.46, SD = 0.75), making an unoccupied bed (M = 5.38, SD = 0.88), and oral temperature (M = 5.30, SD = 0.87). Students were least confident in the fitting for cane (M = 1.74, SD = 1.16) and ambulation with crutches on steps (M =1.81, SD = 1.27). Nursing assistant employment increased student confidence with basic nursing care. Nursing programs cannot assume that students are prepared in basic nursing care based on a nursing assistant certification. © 2014.
Looff, P.C. de; Kuijpers, E.; Nijman, H.L.I.
During a total of 30 shifts, the arousal levels of 10 psychiatric nurses were assessed while working on a (forensic) psychiatric admissions ward. Arousal was assessed by means of a small device (wristband) by which the Skin Conductance Level (SCL) of the participating nurses was monitored. Each nurs
Looff, P.C. de; Kuijpers, E.; Nijman, H.L.I.
During a total of 30 shifts, the arousal levels of 10 psychiatric nurses were assessed while working on a (forensic) psychiatric admissions ward. Arousal was assessed by means of a small device (wristband) by which the Skin Conductance Level (SCL) of the participating nurses was monitored. Each
Chang, Larry W.; Alamo, Stella; Guma, Samuel; Christopher, Jason; Suntoke, Tara; Omasete, Richard; Montis, Jennifer P.; Quinn, Thomas C.; Juncker, Margrethe; Reynolds, Steven J
Background There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. Methods We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected. Results Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately two years later. Viral load testing demonstrated that 86% of active patients (211 of 246 tested) had a viral load <400 copies/mL. The median CD4 increase for active patients was 197 cells/mm3 (IQR, 108–346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at one year and 82% at two years. WHO stage 4 was predictive of both not sustaining therapy and increased mortality. Conclusions A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a two year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care. PMID:19194316
van Oostveen, Catharina J; Ubbink, Dirk T; Mens, Marian A; Pompe, Edwin A; Vermeulen, Hester
To investigate the reliability, validity and feasibility of the RAFAELA workforce planning system (including the Oulu patient classification system - OPCq), before deciding on implementation in Dutch hospitals. The complexity of care, budgetary restraints and demand for high-quality patient care have ignited the need for transparent hospital workforce planning. Nurses from 12 wards of two university hospitals were trained to test the reliability of the OPCq by investigating the absolute agreement of nursing care intensity (NCI) measurements among nurses. Validity was tested by assessing whether optimal NCI/nurse ratio, as calculated by a regression analysis in RAFAELA, was realistic. System feasibility was investigated through a questionnaire among all nurses involved. Almost 67 000 NCI measurements were performed between December 2013 and June 2014. Agreement using the OPCq varied between 38% and 91%. For only 1 in 12 wards was the optimal NCI area calculated judged as valid. Although the majority of respondents was positive about the applicability and user-friendliness, RAFAELA was not accepted as useful workforce planning system. Nurses' performance using the RAFAELA system did not warrant its implementation. Hospital managers should first focus on enlarging the readiness of nurses regarding the implementation of a workforce planning system. © 2015 John Wiley & Sons Ltd.
This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. "Gazetted" acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990-1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute "gazetted" beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. "Non-gazetted" beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.
Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L; Sloane, Douglas M; Aiken, Linda H; Sermeus, Walter
This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone. © The Author(s) 2015.
DeRienzo, Christopher M; Shaw, Ryan J; Meanor, Phillip; Lada, Emily; Ferranti, Jeffrey; Tanaka, David
We demonstrate how to develop a simulation tool to help healthcare managers and administrators predict and plan for staffing needs in a hospital neonatal intensive care unit using administrative data. We developed a discrete event simulation model of nursing staff needed in a neonatal intensive care unit and then validated the model against historical data. The process flow was translated into a discrete event simulation model. Results demonstrated that the model can be used to give a respectable estimate of annual admissions, transfers, and deaths based upon two different staffing levels. The discrete event simulation tool model can provide healthcare managers and administrators with (1) a valid method of modeling patient mix, patient acuity, staffing needs, and costs in the present state and (2) a forecast of how changes in a unit's staffing, referral patterns, or patient mix would affect a unit in a future state.
Hart, Patricia; Davis, Nancy
This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.
Aiken, Linda H
Pay-for-performance initiatives have renewed interest in payment reform as a vehicle for improving nurse staffing and working conditions in hospitals because of research linking investments in nursing and better patient outcomes. This article addresses the economics of nursing from a broad perspective that considers how both national policies such as hospital prospective payment and managerial decisions within institutions impact the outcomes of nurses and patients. Cost offsets are considered from the perspective of savings in patient-care resources that accrue from investments in nursing. Cost offsets are also considered from the perspective of the interactions among different strategies for investing in nursing, including the impact of staffing levels on patient outcomes with varying educational levels of nurses and varying quality of practice environments.
Castle, Nicholas G.; Engberg, John
Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality,…
Mijailovic, Aleksandar S; Tanasijevic, Milenko J; Goonan, Ellen M; Le, Rachel D; Baum, Jonathan M; Melanson, Stacy E F
Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care. To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows. We used staffing levels and patient venipuncture volumes to derive the estimated capacity, a parameter that helps predict the number of patients a location can accommodate per unit of time. We then used this parameter to determine whether a particular phlebotomy site was overstaffed, adequately staffed, or understaffed. Patient wait-time and satisfaction data were collected to assess the efficacy and accuracy of the staffing tool after implementing the staffing changes. In this article, we present the applications of our approach in 1 overstaffed and 2 understaffed phlebotomy sites. After staffing changes at previously understaffed sites, the percentage of patients waiting less than 10 minutes ranged from 88% to 100%. At our previously overstaffed site, we maintained our goal of 90% of patients waiting less than 10 minutes despite staffing reductions. All staffing changes were made using existing resources. Used in conjunction with patient wait-time and satisfaction data, our outpatient phlebotomy staffing tool is an accurate and flexible way to assess capacity and to improve patient wait times.
Objective To explore ladder and compensation system of nurse-staffing which is suitable for the situation of our country.Methods The ladder management and compensation system to nursestaffing of National Health Service (NHS) in UK were given detailed introduction and analysis through the official documents,references and personal study experiences,and summarize its scientific and referenced aspects.Results NHS has formed a set of mature competency-based ladder system,and linked the ladder system to compensation system,made a relative scientific performance appraisal system,realized the scientific "competency matches the level,salary changes along with the level" model.Conclusions It provides references and thinking to the in-depth reform of public hospitals in our country,and the development of high quality nursing service,as well as the implementation of nursing ladder management and compensation reform.%目的 探讨适合我国国情的护理人员分级与薪酬体系.方法 查阅文献及相关资料,并结合个人研修经历,对英国国家健康服务体系进行详细介绍、分析,总结其科学、可借鉴之处.结果 英国国家健康服务体系已经形成一套成熟的岗位能级分层制度,并将分级与薪酬体系一体化,制订了较科学的绩效考核方案,实现了“分级明确,能级对应,以级定薪,级变薪变”的科学管理模式.结论 英国护理人员分级和薪酬体系为我国深化公立医院改革,开展优质护理服务,实施护理人员岗位分级管理和薪酬改革提供借鉴.
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.103 Section 1952.103... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (“benchmarks”) necessary for a “fully effective” enforcement program were required for...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.323 Section 1952.323... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.343 Section 1952.343... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, Compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.213 Section 1952.213... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.263 Section 1952.263... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (“benchmarks”) necessary for a “fully effective” enforcement program were required for...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.373 Section 1952.373... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.363 Section 1952.363... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (“benchmarks”) necessary for a “fully effective” enforcement program were required for...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.163 Section 1952.163... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.203 Section 1952.203... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.153 Section 1952.153....153 Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (“benchmarks”) necessary for a “fully effective” enforcement program were...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.293 Section 1952.293... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.223 Section 1952.223... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.233 Section 1952.233... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.113 Section 1952.113... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.93 Section 1952.93....93 Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were...
... 29 Labor 9 2010-07-01 2010-07-01 false Compliance staffing benchmarks. 1952.353 Section 1952.353... Compliance staffing benchmarks. Under the terms of the 1978 Court Order in AFL-CIO v. Marshall, compliance staffing levels (benchmarks) necessary for a “fully effective” enforcement program were required to...
Campaigns for safe nurse staffing levels have focused invariably on our hospitals, where the absence of sufficient suitably qualified nursing staff is often easy to identify. However, the problem is just as prevalent in the community, where patients and other service users are suffering because district nurses and those in similar roles are overstretched.
Full Text Available That the organizations' being in a changing environment necessitated the permanent change. To keep pace with this change is possible with both developing the organizations' physical and technological possibilities and improving human resources. Especially, the prime duty of hospitals which appear in health sector is to produce service. Due to this feature, human resources have a greater importance than the other sectors. Organizations want their employees to show maximum level of performance. However, employees may show negative attitudes about organizations because of some reasons. This attitude is explained by the concept 'cynism' whose origin is based on ancient Greek.The aim of this study is to determine the employees' organizational cynism levels. What's more, the aim is to determine whether there is a significant difference between employees' organizational cynism levels and their age, educational status, length of service in the profession and the length of service in the hospital. Within the scope of the study, a questionnaire was applied to 391 nurses and the results were analyzed statistically. At the result of the study, it can be expressed that nurses show intermediate level of organizational cynism behavior. Furthermore, a significant difference was found between nurses' the length of service in the profession and behavioral dimension which is out of organizational cynism dimensions, between cognitive dimension and the length of work, between affective dimension with the cognitive dimension and educational status. A significant difference wasn't found between age variable and organizational cyni sm dimensions.
Zhou, Wenjuan; He, Guoping; Wang, Honghong; He, Ying; Yuan, Qun; Liu, Dan
In this study, we focused on measuring levels of nurse burnout and job dissatisfaction in the daily practice of nurses in Hunan province, China, analyzed factors related to nurse burnout and job dissatisfaction, and explored the relationship between them. Previous studies have shown a high level of burnout and job dissatisfaction among nurses worldwide. A cross-sectional survey of 1100 nurses was conducted. The nurses worked at 20 hospitals in 11 cities and counties throughout China's Hunan province. Nurse burnout was measured by the Maslach Burnout Inventory. Nurse-rated job dissatisfaction was described using a four point scale, and work environment was measured using the Nursing Work Index - Practice Environment Scale. The results showed that nurses had high burnout scores and were dissatisfied with their jobs. Staffing, work environment, and work hours were all significantly associated with nurse burnout and job dissatisfaction. Adequate staffing, improved work environment, and reasonable work hours are related to decreasing nurse burnout and job dissatisfaction.
ADFL Bulletin, 2003
Provides the Modern Language Association's salary recommendations for entry-level full-time and part-time foreign language department faculty, as well as general staffing recommendations. (Author/VWL)
Ko, Woonhwa; Kiser-Larson, Norma
Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.
Busby-Parker, Michelle N.
The goal of the research was to show the impact of the implementation of support services on admissions and graduation from nursing programs. The use of support services has been linked to higher levels of success in nursing students in the classroom and the work place. As nursing schools experience pressure to increase the student capacity to…
Klein, Eric E
Justification of clinical physics staffing levels is difficult due to the lack of direction as how to equate clinical needs with the staffing levels and competency required. When a physicist negotiates staffing requests to administration, she/he often refers to American College of Radiology staffing level suggestions, and resources such as the Abt studies. This approach is often met with questions as to how to fairly derive the time it takes to perform tasks. The result is often insufficient and/or inexperienced staff handling complex and cumbersome tasks. We undertook development of a staffing justification grid to equate the clinical needs to the quantity and quality of staffing required. The first step is using the Abt study, customized to the clinical setting, to derive time per task multiplied by the anticipated number of such tasks. Inclusion of vacation, meeting, and developmental time may be incorporated along with allocated time for education and administration. This is followed by mapping the tasks to the level of competency/experience needed. For example, in an academic setting the faculty appointment levels correlate with experience. Non-staff personnel, such as IMRT QA technicians or clerical staff, should also be part of the equation. By using the staffing justification grid, we derived strong documentation to justify a substantial budget increase. The grid also proved useful when our clinical demands changed. Justification for physics staffing can be significantly strengthened with a properly developed data-based time and work analysis. A staffing grid is presented, along with a development methodology that facilitated our justification. Though our grid is for a large academic facility, the methodology can be extended to a non-academic setting, and to a smaller scale. This grid method not only equates the clinical needs with the quantity of staffing, but can also help generate the personnel budget, based on the type of staff and personnel required
Rees, P G; Hays, B J
1. Levels of nursing expertise described by Benner--novice, advanced beginner, competent, proficient, and expert--hold potential for fostering improved practice among occupational health nurses. 2. Lacking a clear understanding of the full potential of the role of the occupational health nurse, employers may not reward the development of clinical expertise that incorporates employee advocacy within the context of written standards and guidelines. 3. Expertise in occupational health nursing can be fostered by job descriptions that incorporate a broader view of nursing (one that stresses judgment and advocacy), retention and longevity, innovative strategies for consultation and collegial interaction to foster mentoring, and distance learning strategies.
Full Text Available Introduction: A nurse who experience burnout feelings will influence their motivation, and quality performance. This situation is probably affecting a decline in work quality towards the caring behaviour demonstrated by nurses to their patiens, particularly for a nurse who are working in the long-stay installation room facing directly to patient's problems. The purpose of this research is to identify the work stress level of nurse towards the nurse's caring behaviour in the long-stay installation room (IRNA in general hospital in Malang. Method: This research used descriptive – correlational, the sampling was Non Probability Purposive Sampling with 93 nurses as the corresponds. The data was analyzed by operating Correlation Pearson, with a significance of p < 0.05. Result: The result found that there was a substantial correlation between the work stress level and the nurse's caring behaviour with p = 0.008 and r = -0.274, and it was a negative correlation. Discussion: It means that when the stress level of nurses will declined, the nurse's caring behavior automatically will beamplified. Conversely, if the stess level of nurses intensively increased, the nurse's caring behaviour become decreased. Thus, this research is needed to be analyzed further in order to asses the quality of caring behaviour by expanding the connected indicator and variable. It is aimed to improve the professionalism and quality of nurses in giving the best service to patients this research need to be continued further in order to asses the quality of nurse's caring behavior by expanding the variable, which is related to internal factors, such as knowledge, perception, emotion, ect and also connected to external factors, such as environment, both physically and non physically like: climate, human being, social economic, culture and ect.
Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M
Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
Chappel, Stephanie E; Verswijveren, Simone J J M; Aisbett, Brad; Considine, Julie; Ridgers, Nicola D
Nurses' physical performance at work has implications both for nurses' occupational health and patient care. Although nurses are the largest healthcare workforce, are present 24-hours a day, and engage in many physically demanding tasks, nurses' occupational physical activity levels are poorly understood. The aim of this systematic review was to examine nurses' occupational physical activity levels, and explore how nurses accumulate their physical activity during a shift. This narrative systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement. EBSCOHost (MEDLINE, CINAHL, Age Line, Academic Search Complete, Global Health, Health Business Centre, Health Policy Reference Centre, Health Source (Consumer and Nursing/Academic Edition) and SPORTDiscus), Embase, Informit, ProQuest Health and Medical, Science Direct, Scopus, and Web of Science databases. A systematic search of seven databases were completed to locate peer-reviewed journal articles documenting nurses' occupational physical activity levels from January 1990. Papers were included if they were original research papers; measured physical activity objectively and/or subjectively; reported nurses' occupational physical activity; and were published in English. Articles were excluded if nurses' data were not reported separately from other professional groups. Two researchers independently screened the articles, extracted data, and undertook the methodological quality assessments. Fifteen studies met the inclusion criteria. Nursing work predominantly comprised of light-intensity physical activity. In nine studies how nurses' accumulated occupational physical activity were documented and showed that the majority of a nurses' shift was spent standing or walking whilst completing direct patient care tasks. However, the definition of the nursing populations studied were often poorly reported, and few researchers reported the validity and the reliability of
The following discussion describes the early findings of a doctoral study, due for completion in 2001. The findings represent data collected in the USA, Australia, New Zealand and the UK, from nurses deemed to be engaged in advanced nursing practice. The paper will review the need for the study and provide a brief overview of the methodology employed. The current status of the findings, utilizing open coding, is presented. Major categories identified thus far are enhancing patient stay, improving patient outcome, promoting the role, trustworthiness, tenacity and survival in the role. The categories identified clarify current understanding of the concept, advanced nursing practice.
Riemer, Heather C; Mates, Joanna; Ryan, Linda; Schleder, Bonnie J
The benefits of quiet time, a therapeutic method of improving the health care environment, have been evaluated in patients, but only a few studies have examined the effects of quiet time on intensive care nurses. To evaluate the effects of implementing quiet time in a medical-surgical intensive care unit on levels of light, noise, and nurses' stress. Quiet time consisted of turning down the unit lights for a designated time. Levels of light, noise, and nurses' stress were measured. Nurses' stress levels were measured by using a 100-point visual analog scale; unit noise, by using a digital sound level meter (model 407736, Extech Instruments); and unit light, by using an illumination light meter (model 615, Huygen Corporation). Measurements were obtained 30 minutes before and 30 minutes, 1 hour, and 2 hours after implementation of quiet time. Analysis of variance and comparisons of means indicated that both light levels and nurses' stress levels were significantly decreased after quiet time (both P levels were also decreased after quiet time, but the decrease was not significant (P = .08). Use of quiet time resulted in decreased light levels and decreased stress levels among nurses. Quiet time is an easily performed energy-saving intervention to promote a healthy work environment. ©2015 American Association of Critical-Care Nurses.
Kim, Sungjae; Kim, Jinhyun
The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.
Kim, Dong Hee; Moon, Seongmi; Kim, Eun Jung; Kim, Young-Ju; Lee, Sunhee
The development of critical thinking dispositions has become an important issue in nursing education in Korea. Nursing colleges in Korea have developed teaching strategies and curricula that focus on developing critical thinking dispositions. It is an imperative step that evaluates the changing pattern and development of students' critical thinking dispositions. This study identified critical thinking dispositions of Korean nursing students according to academic level and satisfaction with nursing. A cross-sectional questionnaire survey was conducted among 1074 students in four colleges who completed the self-reported Critical Thinking Disposition Scale. Descriptive and univariate general linear model analyses were performed. The critical thinking disposition score increased according to academic level until junior year, after which it decreased in the senior year. Nursing students who were satisfied with nursing reported higher levels of critical thinking than those who were not satisfied or who responded neutrally. The critical thinking scores of nursing students not satisfied with nursing dropped greatly in the senior year. These results suggest the importance of targeting the development of curriculum and teaching methods for seniors and students who have a lower level of satisfaction with nursing to increase their critical thinking dispositions. Copyright © 2013 Elsevier Ltd. All rights reserved.
Thomas, Kali S.
Purpose: Individuals receiving postacute care in skilled nursing facilities often require complex, skilled care provided by licensed nurses. It is believed that a stable set of nursing personnel is more likely to deliver better care. The purpose of this study was to determine the relationships among licensed nurse retention, turnover, and a 30-day rehospitalization rate in nursing homes (NHs). Design and Methods: We combined two data sources: NH facility-level data (including characteristics of the facility, the market, and residents) and the Florida Nursing Home Staffing Reports (which provide staffing information for each NH) for 681 Florida NHs from 2002 to 2009. Using a two-way fixed effects model, we examined the relationships among licensed nurse turnover rates, retention rates, and 30-day rehospitalization rates. Results: Results indicate that an NH’s licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = −.02, p = .04) controlling for demographic characteristics of the patient population, residents’ preferences for hospitalization, and the ownership characteristics of the NH. The NHs experiencing a 10% increase in their licensed nurse retention had a 0.2% lower rehospitalization rate, which equates to 2 fewer hospitalizations per NH annually. Licensed nurse turnover is not significantly related to the 30-day rehospitalization rate. Implications: These findings highlight the need for NH administrators and policy makers to focus on licensed nurse retention, and future research should focus on the measures of staff retention for understanding the staffing/quality relationship. PMID:22936529
Lin, Chun-Chih; Han, Chin-Yen; Pan, I-Ju; Lin, Pi-Li
The core values of nursing are a standard component of the nursing curriculum in Taiwan. Therefore, these values provide an essential guide for educating and evaluating the learning outcomes of nursing students. Student perceptions of those core values that relate to the process of curricula learning are key to measuring the core values of nursing. This study explores the views on the core values of nursing of baccalaureate-level nursing students at a Taiwanese university. This qualitative study collected data from the reflection reports of 109 students and analyzed these data using thematic content analysis. The results of this study identified that the learning of core values of nursing tends to utilize the latent curriculum rather than the open curriculum. Critical thinking was perceived and experienced by asking "why." General clinical skills and basic biomedical science were categorized collectively as care ability, which relates to the thinking, analysis, and mapping of client health problems. The value of communication and teamwork capability was defined as the sequential process of accepting, interacting, communicating, and collaborating. Caring was defined as contributing empathy with respect to one's self and to others. Ethics was defined as a moral perspective, as respecting others, and as prioritizing the needs of clients. Accountability was defined as a way of observing standards within the role given in a position. Finally, lifelong learning is a process of learning that encourages more aggressive learning. The progress of core values of nursing in this study reflects positive movement and achievement. The participants expressed the perception that the core values of nursing enhance understanding, which enables nursing educators to reframe the nursing curriculum to meet their learning needs. The perceptions of nursing students of core values of nursing may be used as a guide to increase clinical nursing competence in healthcare.
Full Text Available This study applied engineering techniques to develop a nurse scheduling model that, while maintaining the highest level of service, simultaneously minimized hospital-staffing costs and equitably distributed overtime pay. In the mathematical model, the objective function was the sum of the overtime payment to all nurses and the standard deviation of the total overtime payment that each nurse received. Input data distributions were analyzed in order to formulate a simulation model to determine the optimal demand for nurses that met the hospital’s service standards. To obtain the optimal nurse schedule with the number of nurses acquired from the simulation model, we proposed a genetic algorithm (GA with two-point crossover and random mutation. After running the algorithm, we compared the expenses and number of nurses between the existing and our proposed nurse schedules. For January 2013, the nurse schedule obtained by GA could save 12% in staffing expenses per month and 13% in number of nurses when compare with the existing schedule, while more equitably distributing overtime pay between all nurses.
McQuide, Pamela A; Kolehmainen-Aitken, Riitta-Liisa; Forster, Norbert
As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization. The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers. The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level. WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses' workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7) and health centers (range = 2 to 57). The utility of
Yu, Hsing-Yi; Tang, Fu-In; Chen, I-Ju; Yin, Teresa J C; Chen, Chu-Chieh; Yu, Shu
To investigate inactive nurses' human capital, intention to return to hospital nursing and incentives for returning. Few studies have discussed the loss of human capital with regard to inactive nurses and how to attract them to return to clinical work. Systematic random sampling was used, with 328 subjects completing the mailed questionnaires, resulting in a response rate of 25.4%. Inactive nurses not only had moderate to high human capital (average years of nursing experience was 10.29, with moderate to high levels of nursing professional commitment and nursing competence) and were young. Forty-three percent of subjects reported intending to return to hospital nursing. Sufficient nurse staffing, greater safety in the working environment, and re-entry preparation programmes were incentives for returning. Recruiting inactive nurses back to hospital work is vital and feasible as inactive nurses had a moderate to high degree of human capital. The most feasible way is offering reasonable working conditions, in particular, providing sufficient staffing, a safe working environment and re-entry preparation programmes. The findings confirm the human capital of inactive nurses and provide concrete directions for nursing managers to follow when recruiting inactive nurses to hospital nursing. © 2015 John Wiley & Sons Ltd.
... Staffing, Insight Global Staffing, and Technisource, Scarborough, ME; Amended Certification Regarding..., Inc., including on-site leased workers from Balance Staffing, Insight Global Staffing, and... from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who...
Introduction As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization. Application The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers. Challenges The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level. Findings WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses’ workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7
Stone, Patricia W; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C; Furuya, E Yoko; Larson, Elaine
The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.
Kallis, M J
This article briefly suggested that a marketing perspective may aid hospital administrators and nursing directors in meeting their RN staffing needs. It proposes that adoption of the marketing concept (i.e., being responsive to the needs and wants of the relevant public) will help diminish the shortage of qualified RNs being experienced today. Other specific marketing tools may further aid in implementing the consumer orientation in such institutions. Additional research should further investigate the extent to which such marketing approaches can help in overcoming the problems the health care field is facing today.
Medical Staffing Requirements for Humanitarian Assistance Missions complicated by the cooperative nature of working with NGOs, since it is difficult...Improved mortality rate Improved psychological health Hernia repair Cataracts siuge:y Sîurgery Postoperative care OR Nursing Staff Anesthesiobgjsts
Conclusions: For ICU nurses in China, sources of job dissatisfaction are potentially remedied with simple interventions. Adequate staffing is necessary but not sufficient for a positive work environment. Administrators should address the factors that directly affect their nurses' levels of job satisfaction, as it will ultimately result in less staff turnover and greater patient care.
Full Text Available INTRODUCTION: Community health is very much important in nursing education. It is essential because it maximizes the health status of individuals, families, groups and the community through direct approach with them. The main purpose of the study was to identify the gap in Community Health Nursing I course in Proficiency Certificate Level first year nursing program in Nepal. METHODS: Mix methods of research having qualitative and quantitative method were used in the study. Data were collected from 12 subject teachers, 35 nursing graduates and 61 Proficiency Certificate Level first year nursing students. The study used structured, five-point rating scale and open ended questions according to Strengths, Weaknesses, Opportunities and Threats analysis for the self-administered questionnaire. FINDINGS: Common view points of the three sector's respondents (student, nursing graduate and teachers regarding the strengths of curriculum are: curriculum is based on Primary Health Care approach and covers preventive and promotive aspects of health. Regarding weaknesses, they said that there is inadequate time for practice, there is lack of innovative methods and materials, the course didn't cover new trends of environmental pollution and changes, global warming, greenhouse effect, climate change and deforestation etc. Similarly, they added that curriculum is not revised regularly and there is insufficient supervision in field. Likewise, regarding opportunities, they said that there is job opportunity in social organization as Community Health Nursing/Public Health Nurse. Moreover, they said that there is lack of employment scope as threats point. CONCLUSION: The paper concludes that new issues and trends of community health nursing should be added, and curriculum should be revised regularly.
Bishop, Christine E; Squillace, Marie R; Meagher, Jennifer; Anderson, Wayne L; Wiener, Joshua M
To estimate the impact of nursing home work practices, specifically compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants' employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants' overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Wages, benefits, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfied when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.
Scott-Cawiezell, Jill; Pepper, Ginette A; Madsen, Richard W; Petroski, Greg; Vogelsmeier, Amy; Zellmer, Dave
Providing safe nursing home care is both a clinical and fiscal challenge in many countries. The fiscal realities result in the addition of other workers, such as medication technicians or aides (CMT/A), to the health care team. The purpose of this study was to determine the impact of various levels of credentialing among nursing home staff who deliver medications (RN, LPN, or CMT/A) on medication error. In addition, the impact of distractions and interruptions was explored. Using naïve observation, 39 medication administrators representing various levels of credentialing were unobtrusively observed to determine the number of medication errors, distractions, and interruptions in five nursing homes. There were no differences in medication error rates by level of credential. However, RNs had more interruptions during their medication administration, and these increased interruptions were associated with increased medication error rates when wrong time errors were excluded (p = .0348).
Cummings, Cynthia L; Connelly, Linda K
In 2014, nursing faculty conducted a study with undergraduate nursing students on their satisfaction, confidence, and educational practice levels, as it related to simulation activities throughout the curriculum. The study was a voluntary survey conducted on junior and senior year nursing students. It consisted of 30 items based on the Student Satisfaction and Self-Confidence in Learning and the Educational Practices Questionnaire (Jeffries, 2012). Mean averages were obtained for each of the 30 items from both groups and were compared using T scores for unpaired means. The results showed that 8 of the items had a 95% confidence level and when combined the items were significant for p confidence and active learning. Based on these findings, it can be assumed that repeated simulation experiences can lead to an increase in student confidence and active learning.
Murgia, Carla; Sansoni, Julita
Not unfrequently stress in nurses is related to work organization. The literature shows that the nursing profession has a high risk of psychological stress. Stress is one of the factors that contributes to inefficiency, increasing staff turnover and sick leave, and reduces the quality and quantity of care , affecting health costs and diminishing work satisfaction. This article presents the results of a study performed to evaluate 34 variables, constituting the Nursing Stress Scale (NSS) , and their level in the nursing staff of a Rome specialistic hospital. Of the 80 nurses who received the questionaire , 49 responded, a sufficient number to make the results of the study significant. The authors illustrate the methods used together with some socio-demographic considerations and how some of these can be correlated to the 7 factors adopted for multi-variate analysis. The results obtained were concordant with those described in the literature, confirming that poor organization and conflictual or ambiguous work roles negatively affect well-being and that nursing directors should bear this in mind when aiming to create a harmonious work environment.
Full Text Available Aim. The theory of emotional intelligence provides a framework to think about all of the non-technical skills you need in order to be a good nurse. It’s often described as the potential to feel, use, communicate, recognize, remember, describe, identify, learn from, manage, understand, and explain emotions. The aim of the study was to determine the level of total global Emotional Intelligence among undergraduate students of nursing and also to check the influence of factors (the year of study, type of completed high school education on Emotional Intelligence.
Montserrat Martínez Lareo
Full Text Available The high costs of intensive care and the importance of patient safety and quality of care highlight the need to develop instrument to measure, as precisely as possible, nursing workload and staffing levels in intensive care. To assess the ideal staff number, we need instruments to measure the real nursing workload. The aim of this research is to compare two nursing workload measurement scales in Intensive Care Units, the Nursing Activities Score (NAS and Nine Equivalents of Nurse Manpower Use Score (NEMS. We also want to assess the staffing needs of our ICU. A descriptive correlational study will be performed in a mixed medical ICU. The sample will be composed of of a minimum of 70 patients. Data regarding individual patients and unit global workload will be recorded, measured both with the NEMS and NAS scales. The required nursing staff will be calculated according to the measured workload. Nursing staffing needs using both scales will be calculated and compared to the actual staff. A descriptive analysis of the variables will be performed, and the existing correlation between both scales will be assessed using the Pearson correlation coefficient. A Student-t test will be performed to determine the differences between the calculated staffing requirements and the actual nursing staff. All data analyses will be done using a statistical software.
Zhang, Hanjing; Tako, Antuela; Lisa M. Jackson; Liu, Jiyin
Motivated by the squeeze on public service expenditure, staffing is an important issue for service systems, which are required to maintain or even improve their service levels in order to meet general public demand. This paper considers Police Patrol Service Systems (PPSSs) where staffing issues are extremely serious and important because they have an impact on service costs, quality and public-safety. Police patrol service systems are of particularly interest because the demand for service e...
Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.
Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik
To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout
Rezayat, Fatemeh; Dehghan Nayeri, Nahid
Nursing students are susceptible to a higher risk of depression. Recognition of depression, assertiveness and the relationship between them is important since if a relationship exists, probably enhancing the level of assertiveness can reduce depression in this high risk group. We aimed to investigate depression and assertiveness levels and the relationship between them in nursing students of Tehran University of Medical Sciences. The target population of this cross-sectional study was bachelor nursing students of Tehran University of Medical Sciences, as the largest and one of the most prestigious Iranian universities. For selecting samples, the convenience sampling method was used. Having no previous information about classes, the researcher selected the students from the courses held while the researcher was present for sampling at the faculty and studied all the students willing to participate in the study in selected classes. The questionnaire consisted of demographic information, Gambrill and Richey assertion inventory, and Beck's depression inventory. SPSS software, version 16, was used to analyze the data. ANOVA and independent samples t test were used for as appropriated. 55.6% of students indicated average and low levels of assertiveness and 38.7% were suffering from mild to severe depression. Pearson correlation test showed a significant inverse relationship (r=0.314 and Passertiveness and depression. There were significant relationships between depression and interest in the field of study (P=0.001) and between assertiveness and gender (P=0.035). There was an inverse significant relationship between depression and assertiveness among nursing students. We suggest a cohort study design that can determine the effect of these variables on each other completely.
Fisher, Anita; Baumann, Andrea; Blythe, Jennifer
Social and economic changes in industrial societies during the past quarter-century encouraged organizations to develop greater flexibility in their employment systems in order to adapt to organizational restructuring and labour market shifts (Kallenberg 2003). During the 1990s this trend became evident in healthcare organizations. Before healthcare restructuring, employment in the acute hospital sector was more stable, with higher levels of full-time staff. However, in the downsizing era, employers favoured more flexible, contingent workforces (Zeytinoglu 1999). As healthcare systems evolved, staffing patterns became more chaotic and predicting staffing requirements more complex. Increased use of casual and part-time staff, overtime and agency nurses, as well as alterations in skills mix, masked vacancy counts and thus rendered this measurement of nursing demand increasingly difficult. This study explores flexible nurse staffing practices and demonstrates how data such as nurse vacancy statistics, considered in isolation from nurse utilization information, are inaccurate indicators of nursing demand and nurse shortage. It develops an algorithm that provides a standard methodology for improved monitoring and management of nurse utilization data and better quantification of vacancy statistics. Use of standard methodology promotes more accurate measurement of nurse utilization and shortage. Furthermore, it provides a solid base for improved nursing workforce planning, production and management.
Olivi, Penny M
The AHRA Board of Directors formed a Long-Term Staffing Task Force to study the question, "Should AHRA become involved in the resolution(s) of the current staffing crisis, and if so how?" Because the background information that could be gathered was extensive, the Task Force used the following four questions to guide its activity: SENSITIVITY TO MEMBERS' VIEWS: What do we know about the needs, wants and preferences of our members, prospective members and customers relevant to a decision to become involved in activities to resolve the staffing crisis? FORESIGHT ABOUT FUTURE ENVIRONMENT: What do we know about the current and evolving dynamics of our profession relevant to a decision to become involved in activities to resolve the staffing crisis? INSIGHT INTO THE ORGANIZATION: What do we know about the strategic position and internal capacity of our organization relevant to a decision to become involved in activities to resolve the staffing crisis? CONSIDERATION OF OUR CHOICES: What are the ethical implications of our choices relevant to a decision to become involved in activities to resolve the staffing crisis? After considerable investigation and discussion, the Task Force made the following recommendations to the Board: RAISE AWARENESS OF OUR PROFESSION: Expand the number of radiologic technologists in the workforce by increasing the diversity of our students and by changing the traditional method in which we educate students (i.e., full-time, day clinical education). Create a quality monitor useful to the majority of radiology leaders to begin to systematically document the shortage. Support limited licensure and/or create a defined position of "staff extender" for radiologic technology.
Ward, David; Phetteplace, Eric
The growth in number and kind of online reference services has resulted in both new users consulting library research services as well as new patterns of service use. Staffing in-person and virtual reference services desks adequately requires a systematic analysis of patterns of use across service points in order to successfully meet fluctuating…
Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis
To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.
Cheung, Robyn B.; Aiken, Linda H.; Clarke, Sean P.; Sloane, Douglas M.
Countries across the globe are experiencing nursing shortages. In hospitals, supportive practice environments have positive effects on both nurse and patient outcomes. However, these relationships have been established primarily in the US. International studies of the effects of nurse staffing levels and the practice environment on nurse outcomes and the quality of care mirror the findings from the US, thus raising these issues to the international level. The solutions that have been successful in the US for improving practice environment and patient outcomes are solutions that should be successful in any country, thus putting them on a global scale. The Magnet hospital program is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses. PMID:18218265
Montserrat Solís Muñoz
Full Text Available Objective: To analyze the levels of scientific evidence on nursing techniques and procedures.Selection of nursing techniques: According to the frequency of daily use, increase in scientific production in the last years, and variability in practise.Sources and data searching: 1. Books and manuals in Specialised libraries and using the Online Point Access Catalog (OPAC. 2. Clinical practise guidelines and protocols from hospitals taking part in the Evidence-Based Medicine network. 3. On-line manuals, clinical practise guidelines and protocols, using different searching strategies and specific language of PubMed, Cochrane Library, CINAHL, IBECS, and others.Revision method: 1. To retrieve the sources of information containing the techniques and procedures. 2. Their identification and description. 3. Assessment of the level of evidence of the studies cited in the sources through critical appraisal, by two observers. If disagreement, a third reviewer will assess the study. 4. Analysis of scientific evidence of techniques and procedures, applying specific criteria and using the highest level of evidence supporting them. 5. Assignment of the level of recommendation for the technique depending on the level of evidence.Analysis and data treatment: With a reference manager databases with sources and references will be created and related to each other.
Sibandze, B T; Scafide, K N
Professional nursing values have been acknowledged globally as the foundation of daily nursing care practice. Understanding how nurses identify, comprehend and apply their professional nursing values is an important step towards improving nursing practice and patient care quality. Research has demonstrated that nurses' professional values are cultivated during prelicensure academic education. The aim of this systematic review was to determine how level of education affects professional nursing values of clinical practising nurses. A systematic search of quantitative research published through December 2015 was performed in the following five electronic databases: CINAHL, Cochrane Library, MEDLINE, Web of Science and Religion and Philosophy Collection. The search was not limited to country of origin. The studies were assessed for methodological quality using established criteria. Of 1501 articles identified through the literature search, only seven studies met the inclusion criteria with the majority being of good to high quality. Most of the studies found registered nurses pursuing a bachelor of science in nursing or higher had a greater awareness and application of professional values than nurses with lower levels of academic or non-academic education. Nurses with higher education also embraced professional values as fundamental for quality nursing care practice. Health and academic institutions should support nurses through quality continuing and higher education that reinforces professional values, thus improving the quality of patient care. The level of nurses' education appears to play an important role in developing both an awareness and an integration of professional values into practice. More research is needed to discover methods that may be used to promote nurses' professional values among nurses already practising clinically. © 2017 International Council of Nurses.
Jennifer L. Embree
Full Text Available Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior.
N. S. Gwele
Full Text Available Change in nursing education in South Africa has been characterised by the predominance of the use of power-coercive strategies to effect change. Changes in nursing curricula are legislated through the South African Nursing Council. The Comprehensive Basic Nursing Programme (CBNP became mandatory for all institutions offering basic professional nurse preparation education programmes in this country in 1985. This was a comparative descriptive study aimed at examining the levels of use of 47 nurse educators at four nursing colleges regarding their behaviours and skills in implementing four selected components of the CBNP. The components of the CBNP which formed the focus for this study were teaching to produce nurses capable of (a rendering comprehensive health care, (b nursing holistically, (c thinking critically, and (d learning independently.
Hanrahan, Nancy P; Aiken, Linda H; McClaine, Lakeetra; Hanlon, Alexandra L
Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.
Full Text Available Background: The research was conducted in order to determine levels of assertiveness and peer pressure of the nursing students.Methodology: This descriptive research has been performed with 154 nursing students in Bozok University, The data were collected with Questionnaire Form, Rathus Assertiveness Inventory and Peer Pressure Scale. We used the data one way Anova, two samples t test, the relationship between several independent variables and scales were evaluated by Pearson correlation technique in order to evaluate the data with normal distribution.Results: It was seen that 69.5% of the students was assertive and mean scores for assertiveness of the male students (19.4±17.9 were higher than that of the female students (29.0±14.1. However, mean scores for peer pressure of the male students (56.6±12.4 were higher than that of the female students (44.0±8.8. It was found out that there was a positive direction middle level significant correlation between mean assertiveness scores and mean peer pressure scores of the studentsConclusion: Although we did not find any significant correlation between mean assertiveness scores and mean peer pressure scores, it was seen that male students were more assertive than female students and male students experienced peer pressure more than female students.
Fullerton, J T; Lantz, J; Quayhagen, M P
The didactic and clinical focus of geriatric curriculum content within both associate (ADN) and baccalaureate (BSN) schools of nursing in California was reviewed. Geriatric nursing content experts confirmed the detail of a geriatric nursing curriculum, then determined which of the content items were basic to both educational levels, and which might be appropriately deferred to programs of baccalaureate preparation. Nurse educators may use the results of this study to guide curriculum development in both depth and breadth of content.
Faller, Marcia; Gogek, Jim
The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.
Callen, Bonnie; Smith, Claudia M; Joyce, Barbara; Lutz, Jayne; Brown-Schott, Nancy; Block, Derryl
The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carper's ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations. © 2013 Wiley Periodicals, Inc.
Harrington, Charlene; Stockton, Julie; Hooper, Sarah
This article examines the effects of state regulation and civil class action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found that the chain violated the state's minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled Healthcare Group's California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight. Copyright © 2014 by Duke University Press.
Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S
Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care.
T. T. Nichols
Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of ''soft'' variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: (1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times ''soft'' variables, such as morale, productivity, and efficiency are the sources of such influences; and (2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.
Nichols, Todd Travis
Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of "soft" variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: 1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times "soft" variables, such as morale, productivity, and efficiency are the sources of such influences; and 2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.
Patrician, Patricia A; McCarthy, Mary S; Swiger, Pauline; Raju, Dheeraj; Breckenridge-Sproat, Sara; Su, Xiaogang; Randall, Kelly H; Loan, Lori A
To more precisely evaluate the effects of nurse staffing on hospital-acquired pressure injury (HAPI) development, data on nursing care hours per patient day (NCHPPD), nursing skill mix, patient turnover (i.e., admissions, transfers, and discharges), and patient acuity were merged with patient information from pressure injury prevalence surveys that were collected annually for the Military Nursing Outcomes Database (MilNOD) project. The MilNOD included staffing and adverse events from 56 medical-surgical, stepdown, and critical care units in 13 military hospitals over a 4-year-period. Data on 1,643 patients were analyzed with Cox proportional hazards models and generalized estimating equations. Staffing was not associated with pressure injuries in stepdown or critical care patients. However, among the 1,104 medical-surgical patients, higher licensed practical nurse (LPN) nursing care hours per patient day (NCHPPD) 3 days and 1 week prior to the HAPI discovery date were associated with fewer HAPI (HR 0.27, p hospital units with more RNs and patient care technicians, and fewer LPNs, hospitals should reconsider LPNs as valuable members of the nursing care team. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Squires, Allison; Beltrán-Sánchez, Hiram
Research that links macro-level socioeconomic development variables to health care human resources workforce composition is scarce at best. The purpose of this study was to explore the links between nonnursing factors and nursing workforce composition through a secondary, descriptive analysis of year 2000, publicly available national nursing human resources data from Mexico. Building on previous research, the authors conducted multiple robust regression analysis by federal typing of nursing human resources from 31 Mexican states against macro-level socioeconomic development variables. Average education in a state was significantly associated in predicting all types of formally educated nurses in Mexico. Other results suggest that macro-level indicators have a different association with each type of nurse. Context may play a greater role in determining nursing workforce composition than previously thought. Further studies may help to explain differences both within and between countries.
Full Text Available Introduction:Nowadays health care system is facing inappropriate special staffing distribution challenge not only in Iran bur all over the world. Current study has been done with purpose of survey on How to allocate nursing force to selected hospitals of Tehran Medical Science University. Research Method:This study is descriptive analytical and its studying society includes all units with nursing personnel (Nurse, Paramedic and Nurse Aids in Shariati Hospital of Tehran Medical University. Data has been gathered through self-made forms of researcher and its analysis has been done by Excel, descriptive statistic indexes and recommended Standards guidance by Health Ministry. Finding:Results of Estimations in 16 units of studying hospital and comparing it to current situation shows that based on Health Ministry’s recommended pattern, only one unit (6.25% was matched by this pattern from staffing, 11 units (66.75% were lower and 4 units (25% were upper than this pattern. Conclusion:It seems staffing distribution in studying hospital doesn’t follow and specific pattern and this is more affected by ministerial circulars and instructions. So it suggests that staffing schematization model be planned and performed by health system particles.
Full Text Available Objective: The aim of this study is to determine the knowledge levels of oncology nurses about peripheral and central venous catheter during their chemotherapy administration. Methods: Data collection of this descriptive study was started on April 15, 2015–July 15, 2015. The data presented in this summary belong to 165 nurses. Data were collected with data collection form including questions related to sociodemographic qualifications and knowledge levels of nurses. Data collection forms were E-mailed to the members of Turkish Oncology Nursing Society. Data presented with numbers, percentages, and mean ± standard deviation. Results: The mean age of nurses was 33.60 ± 7.34 years and mean duration for oncology nursing experience was 2.65 ± 0.91 years. Nurses had correct information about the importance of selecting peripheral venous catheter and choosing the placement area for chemotherapy administration (63.6%, control of catheter before the administration (93.9%, influence of chemotherapeutic agent on length of catheter (40.6%, and management of extravasation (75.7%. Nurses also had correct information about the first use of port catheter (67.3% and checking the catheter whether it is working properly or not (75.8%. Conclusions: In General, nurses' level of knowledge related to catheter is 50% and higher. It is recommended to increase the knowledge of nurses about evidence-based information for catheter care as a step to safe chemotherapy practice.
Full Text Available Aim: The aim of this study was to determine knowledge levels of students in School of Health, Kahramanmaras Sutcu Imam University, and examine the influence of various factors on hepatitis B knowledge levels. Method: The study was conducted in the School of Health of Kahramanmaras Sutcu Imam University between April and June 2009. All of the 296 students in the school were planned to be included in the study. Survey forms; prepared in the light of the data reported in the literature by investigators, and composed of 37 questions, were delivered to the students and they were asked to fill them out. 18.2% of the students couldn’t be reached. Thus, only 242 students (81.8% were included in the study. Results: While 87.2% of the students expressed sexual intercourse as a transmission route of HBV, 67.4% mentioned perinatal route, 96.7% expressed blood and blood products, 79.8% mentioned use of common goods such as towel and toothbrush. 78.1% of the students did not consider breast milk as a transmission route for HPV, whereas fecal-oral route, handshake-hugging, and kissing were not known to be a way of transmission for HPV in 65.7%, 86.8%, and 56.2% of the study population, respectively. Mean level of hepatitis B knowledge among students was 69.8±19.4. Knowledge score of nursing students was 1.1 points higher than that of midwifery students and the difference between them was not significant. As the college year elevated, hepatitis B knowledge scores increased as well. Conclusion: Hepatitis B knowledge score of undergraduate students in Nursing and Midwifery Departments of Kahramanmaras Sutcu Imam University, was 69.8±19.4. Since hepatitis B knowledge score raises parallel to the elevation of college year, hepatitis B education should be provided in the first year. [TAF Prev Med Bull 2011; 10(2.000: 139-144
Full Text Available Background: Working time is a non-renewable and important element in the management of an organization. The implementation of changes in the structure of working time may be facilitated by the insight into activities undertaken by employees during work. Such an approach plays an important role since the effective use of time improves the quality of care, prevents timewasting and optimizes the use of the full potential of employees, including nurses. The objective of the study was to determine the structure of working time of pediatric nurses in hospital wards of 2 referential levels. Material and Methods: The study was conducted in 2 wards (2nd and 3rd levels of reference in the Regional Specialist Children’s Hospital in Olsztyn. The research method involved the measurement of working time, as well as continuous and snap-shot observation techniques. Standardized research instruments were used in the study; 8 continuous observations and 2333 snap-shot observations were carried out. Results: In the structure of working time of pediatric nurses indirect nursing-related activities predominated (52.2%. Direct nursing made 28.7% of the working time. The nurses devoted the smallest amount of time to coordination and organization – 8%. The percentage of time associated with non-duty activities and breaks at work was 11.1%. In direct nursing activities associated with diagnosing (9% and treatment (11.7% prevailed. In indirect nursing activities pertaining to documentation of activities related to direct nursing made 24.6%. Conclusions: Pediatric nurses devote insufficient amount of time to direct nursing. Activities associated with documentation of activities related to direct nursing, preparation for direct nursing, as well as treatment and diagnosing predominate in the working time structure of nurses. Med Pr 2017;68(1:95–103
Mohammad Hosein Vaziri
Full Text Available The purpose of this study was to describe the moral distress among Iranian registered nurses.This was a descriptive -analytic study, in which 264 out of 1000 nurses were randomly selected as a sample group and completed the questionnaire. The nurses' moral distress was assessed using Corley's 30-item Moral Distress Scale adapted for use in an Iranian population. The collected data were analyzed by SPSS version 19.In this study, no correlation was found between the level of moral distress and any of the demographic data. The mean moral distress score ranged from 3.56 to 5.83, indicating moderate to high levels of moral distress. The item with the highest mean score was "working with unsafe levels of nurse staffing". The item with the lowest mean score was "giving medication intravenously to a patient who has refused to take it". Nurses working in EMS and NICU units had the highest levels of moral distress.A higher degree of moral distress is observed among nurses who work in health care systems. The results of this study highly recommend practical and research-oriented evaluation of moral distress in the medical society in Iran. Our findings suggest that Iranian version of MDS is a reliable instrument to measure moral distress in nurses.
Neff, Donna Felber; Cimiotti, Jeannie; Sloane, Douglas M; Aiken, Linda H
To determine whether, and under what circumstance, US hospital employment of non-US-educated nurses is associated with patient outcomes. Observational study of primary data from 2006 to 2007 surveys of hospital nurses in four states (California, Florida, New Jersey and Pennsylvania). The direct and interacting effects of hospital nurse staffing and the percentage of non-US-educated nurses on 30-day surgical patient mortality and failure-to-rescue were estimated before and after controlling for patient and hospital characteristics. Data from registered nurse respondents practicing in 665 hospitals were pooled with patient discharge data from state agencies. Thirty-day surgical patient mortality and failure-to-rescue. The effect of non-US-educated nurses on both mortality and failure-to-rescue is nil in hospitals with lower than average patient to nurse ratios, but pronounced in hospitals with average and poor nurse to patient ratios. In hospitals in which patient-to-nurse ratios are 5:1 or higher, mortality is higher when 25% or more nurses are educated outside of the USA than when nurses are non-US-educated. Moreover, the effect of having >25% non-US-educated nurses becomes increasingly deleterious as patient-to-nurse ratios increase beyond 5:1. Employing non-US-educated nurses has a negative impact on patient mortality except where patient-to-nurse ratios are lower than average. Thus, US hospitals should give priority to achieving adequate nurse staffing levels, and be wary of hiring large percentages of non-US-educated nurses unless patient-to-nurse ratios are low.
Getz, Robert A.
After five years of research, custodial staffing guidelines were developed to determine the proper custodial staffing of office, classroom, and laboratory facilities, including ways to tailor the staffing for specific circumstances. Four figures illustrate the factors involved. (MLF)
The European Federation of Organisations for Medical Physics. Policy Statement No. 7.1: The roles, responsibilities and status of the medical physicist including the criteria for the staffing levels in a Medical Physics Department approved by EFOMP Council on 5th February 2016.
Evans, Stephen; Christofides, Stelios; Brambilla, Marco
This EFOMP Policy Statement is an amalgamation and an update of the EFOMP Policy Statements No. 2, 4 and 7. It presents guidelines for the roles, responsibilities and status of the medical physicist together with recommended minimum staffing levels. These recommendations take into account the ever-increasing demands for competence, patient safety, specialisation and cost effectiveness of modern healthcare services, the requirements of the European Union Council Directive 2013/59/Euratom laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation, the European Commission's Radiation Protection Report No. 174: "Guidelines on medical physics expert", as well as the relevant publications of the International Atomic Energy Agency. The provided recommendations on minimum staffing levels are in very good agreement with those provided by both the European Commission and the International Atomic Energy Agency. Copyright © 2016. Published by Elsevier Ltd.
Full Text Available The purpose of this paper is to provide a clear definition of nursing care quality that contributes to the formulation, application, and measurement of quality nursing outcomes for patients, organisations, and nursing staff. It also indicates the manner in which, by using the definition, empirically based operational definitions can be developed for different operational environments and settings. The study employed a concept analysis methodology to extract terms, attributes, antecedents, and consequences (outcomes from relevant literature databases. The analysis identified nine attributes: nurse competency performance, met nursing care needs, good experiences for patients, good leadership, staff characteristics, preconditions of care, physical environment, progress of nursing process, and cooperation with relatives. Antecedences include nurse-staffing levels, positive practice environment, and nursing turnover. Consequences include patient safety, patient satisfaction, nursing outcomes, nurse satisfaction, and budget management. Because of the breadth and depth of modern nursing practice, further research and development of the concept is required. [Int J Res Med Sci 2015; 3(8.000: 1832-1838
Tekin, Fatma; Findik, Ummu Yildiz
Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients.
Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J
To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.
Drake, Stacy A.
Forensic nursing is an emerging nursing specialty recognized by the American Nursing Association. However, nurses often do not have the basic knowledge or practical competence to provide the appropriate level of forensic care. The purpose of this study was to determine if differences in knowledge or practical competence existed between students…
Dikmen, Yurdanur; Karataş, Hülya; Arslan, Gülşah Gürol; Ak, Bedriye
Professionalism is characterized by the degree of dedication displayed by individuals regarding the values and behavioral attributes of a specific career identity. Professionalism indicates attitudes that represent high levels of identification with and commitment to a specific profession. In the process of the professional development of nursing, various factors affect these obstacles which may impede the professional development of nurses and their professional behaviors. This study was carried out with the aim of determining the professional behavior of nurses in a hospital in Turkey. In this descriptive exploratory study a total of 89 nurses working in a public hospital in northwestern of Turkey were participated. Data were collected using a demographic questionnaire and Behavioral Inventory Form for Professionalism in Nursing (BIPN). The result showed that mean scores on the BIPN were 5.07 (3.47). The areas with the highest levels of professional behavior were competence and continuing education 1.88 (0.34). The professionalism levels for nurses were the lowest in the areas of autonomy 0.06 (0.34), publication 0.10 (0.25), and research 0.25 (0.60). There was a statistically significant difference between the total BIPN scores and the education levels of the nurses and the working of nurses. The professional behavior of nurses is at a low level. Since the arrangement of the nurses' working conditions affects their professional behaviors; therefore, development in the field of professional behaviors in nursing must be assessed and supported to increase the quality of patient care.
Melber, B.; Roussel, A.; Baker, K.; Durbin, N.; Hunt, P.; Hauth, J.; Forslund, C.; Terrill, E. [Battelle Human Affairs Research Centers, Seattle, WA (United States); Gore, B. [Pacific Northwest Lab., Richland, WA (United States)
The objective of this report is to identify how decisions are made regarding staffing levels and positions for a sample of U.S. nuclear power plants. In this report, a framework is provided for understanding the major forces driving staffing and the implications of staffing decisions for plant safety. The focus of this report is on driving forces that have led to changes in staffing levels and to the establishment of new positions between the mid-1980s and the early 1990s. Processes used at utilities and nuclear power plants to make and implement these staffing decisions are also discussed in the report. While general trends affecting the plant as a whole are presented, the major emphasis of this report is on staffing changes and practices in the operations department, including the operations shift crew. The findings in this report are based on interviews conducted at seven nuclear power plants and their parent utilities. A discussion of the key findings is followed by a summary of the implications of staffing issues for plant safety.
O'Neill, Thomas R; Marks, Casey; Wendt, Anne
The purpose of this research was to provide sufficient information to the National Council of State Boards of Nursing (NCSBN) to make a defensible recommended passing standard for English proficiency. This standard was based upon the Test of English as a Foreign Language (TOEFL). A large panel of nurses and nurse regulators (N = 25) was convened to determine how much English proficiency is required to be minimally competent as an entry-level nurse. Two standard setting procedures were combined to produce recommendations for each panelist. In conjunction with collateral information, these recommendations were reviewed by the NCSBN Examination Committee, which decided upon an NCSBN recommended standard, a TOEFL score of 220.
El Solh, Ali A
Nursing home-acquired pneumonia (NHAP) was first described in 1978. Since then there has been much written regarding NHAP and its management despite the lack of well-designed studies in this patient population. The most characteristic features of patients with NHAP are the atypical presentation, which may lead to delay in diagnosis and therapy. The microbial etiology of pneumonia encompasses a wide spectrum that spans microbes recovered from patients with community-acquired pneumonia to organisms considered specific only to nosocomial settings. Decision to transfer a nursing home patient to an acute care facility depends on a host of factors, which include the level of staffing available at the nursing home, patients' advance directives, and complexity of treatment. The presence of risk factors for multidrug-resistant pathogens dictates approach to therapy. Prevention remains the cornerstone of reducing the incidence of disease. Despite the advance in medical services, mortality from NHAP remains high.
Kerfoot, Karlene; Douglas, Kathy
Embracing an inclusive leadership style is the foundation of building an approach to staffing that maximizes outcomes for patients, the workforce, and the organizations in which care is delivered. By engaging everyone involved and inviting participation, a structure of shared understanding is created, providing an environment that is positioned to achieve optimal results. Communityship offers a model for approaching leadership that is aligned with leveraging talent across an organization and developing a culture prepared to face the complex challenges of staffing and achieving new levels of performance that an evidence-based approach to staffing excellence can offer. A zero-defect health care system can be achieved by developing communityship.
..., Ultimate Staffing (Roth Staffing Companies), and Aerotek, Cromwell, CT; Amended Certification Regarding... a separate unemployment insurance (UI) tax account for Roth Staffing Companies. The Department has... from Ultimate Staffing (Roth Staffing Companies) and Aerotek working on-site at the...
Park, Jin Hee; Lee, Eun Nam; Kong, Kyung Ran; Jang, Moon Jung
This secondary analysis examined the mediating effect of hardiness between stress and impact level in ED nurses who experienced a violent event. This correlational study was conducted from June to August 2014. We used the visual analog scale to measure stress level, the Impact of Event Scale-Revised to measure impact level after the violent event, and the Dispositional Resilience Scale to measure hardiness. We then analyzed mediating effects with the Sobel test. Data were collected in 31 emergency medical centers located in B city in Korea. Data from 321 ED nurses who experienced a violent event were analyzed. Most nurses (91.9%) were women, with a mean age of 28.73 years. The main outcome measure was the mediating effect of hardiness between stress and impact level after ED nurses experienced violence. We found that both violence-related stress (B = 0.22, P event. Based on results of a Sobel test, hardiness partially mediated the relationship between violence-related stress and impact level from a violent event (Z = 2.03, P = .044). Hardiness had an effect on reducing the impact level of ED nurses who had experienced a violent event and had a mediating role in mitigating their stress. Therefore, we recommend the development of an intervention program that emphasizes the improvement of hardiness in ED nurses. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Full Text Available Introduction: Professionalism is characterized by the degree of dedication displayed by individuals regarding the values and behavioral attributes of a specific career identity. Professionalism indicates attitudes that represent high levels of identification with and commitment to a specific profession. In the process of the professional development of nursing, various factors affect these obstacles which may impede the professional development of nurses and their professional behaviors. This study was carried out with the aim of determining the professional behavior of nurses in a hospital in Turkey. Methods: In this descriptive exploratory study a total of 89 nurses working in a public hospital in northwestern of Turkey were participated. Data were collected using a demographic questionnaire and Behavioral Inventory Form for Professionalism in Nursing (BIPN. Results: The result showed that mean scores on the BIPN were 5.07 (3.47. The areas with the highest levels of professional behavior were competence and continuing education 1.88 (0.34. The professionalism levels for nurses were the lowest in the areas of autonomy 0.06 (0.34, publication 0.10 (0.25, and research 0.25 (0.60. There was a statistically significant difference between the total BIPN scores and the education levels of the nurses and the working of nurses. Conclusion: The professional behavior of nurses is at a low level. Since the arrangement of the nurses’ working conditions affects their professional behaviors; therefore, development in the field of professional behaviors in nursing must be assessed and supported to increase the quality of patient care.
Joseph, M Lindell; Fowler, Debra
The evolving and complex practice environment calls for new mindsets among nurse leaders, academics, and nurse innovators to envision innovative ways to manage and optimize traditional tasks and processes in nursing administration. The purpose of this article is to present 3 case studies that used linear programming and simulation to innovate staffing enterprises, financial management of healthcare systems, and curricula development.
Pazar, Berrin; Demiralp, Meral; Erer, İmren
The most basic component of communication skills is the complex and multidimensional skill of empathy. This study was conducted to assess the communication skills and empathic tendency levels of female nursing students Turkish university. This cross-sectional study sample consisted of 342 nurse student. There was a significant difference between the classes in terms of communication skills (0.021, p .05). The mean communication skills score increased in the final year but empathic tendency levels did not increase with increasing school years. This result suggests that the empathic tendency level could not be increased with the courses in the curriculum in our study. The results suggest that empathic tendency levels were not increased with subsequent nursing coursework. Determining empathic predisposition levels prior to entry into nursing programs should therefore be considered.
Villalobos, N A
The development of the nursing care attention process guided through the PDCA. (plan, do, check, act), provides a continuous improvement of our actual context. The meaning of PDCA is translated as VIDA for: view, implementation, discernment, at just. For its application it takes in view the change theory of Kurt Lewin. This paper provides the results of the Implementation stage using different approaches as technical care, education, administration and research. These strategies show that people did not express their feelings, beliefs and their own expectations and autonomy in nursing care. They even do not develop their citizenship, right of living and being able to grow.
Questionnaire-based survey on structural quality of hospitals and nursing homes for the elderly, their staffing with infection control personal, and implementation of infection control measures in Germany
Full Text Available [english] From January to May 2012, 1,860 hospitals throughout Germany received a questionnaire encompassing 77 items. Additionally, 300 outpatient care services and 310 nursing homes for elderly in Berlin also received a 10-item questionnaire asking on their implemented infection control practices. All questionnaires were anonymous. A total of 229 completed questionnaires from hospitals, 14 questionnaires from outpatient care services, and 16 questionnaires from nursing homes were eligible for further analysis.The lack of Infection Control physicians was identified as the largest issue. In hospitals sized 400–999 beds a gap of 71%, and in hospitals sized ≥1,000 beds a gap of 17% was reported. Depending on the number of hospital beds, 13–29% of hospitals sized ≥100 beds reported not havening one infection control nurse. Since based on the number of beds in larger institutions or in facilities caring for high-risk patients several infection control nurses may be required, the deficiency in infection control nurses may even be higher, particularly in secondary and tertiary care facilities. Furthermore, the analysis revealed that the legal requirements for surveillance and reporting of notifiable infectious diseases have not yet been implemented in 11% of the facilities. The implementation of antibiotic strategies did show significant gaps. However, deficiencies in the implemented measures for the prevention of surgical site infections were less frequent. Yet 12% of the participants did not have a dedicated infection control concept for their surgical services. Eight percent of hospitals were not prepared for an outbreak management and 10% did not have established regulations for wearing surgical scrubs. Deficiencies in waste disposal and the control of air-conditioning systems were also noted. Based on the results of this survey, conclusions on the optimal resource allocation for further improvement of patient safety may be drawn.While all
Questionnaire-based survey on structural quality of hospitals and nursing homes for the elderly, their staffing with infection control personal, and implementation of infection control measures in Germany.
Kramer, A; Assadian, O; Helfrich, J; Krüger, C; Pfenning, I; Ryll, S; Perner, A; Loczenski, B
From January to May 2012, 1,860 hospitals throughout Germany received a questionnaire encompassing 77 items. Additionally, 300 outpatient care services and 310 nursing homes for elderly in Berlin also received a 10-item questionnaire asking on their implemented infection control practices. All questionnaires were anonymous. A total of 229 completed questionnaires from hospitals, 14 questionnaires from outpatient care services, and 16 questionnaires from nursing homes were eligible for further analysis. The lack of Infection Control physicians was identified as the largest issue. In hospitals sized 400-999 beds a gap of 71%, and in hospitals sized ≥1,000 beds a gap of 17% was reported. Depending on the number of hospital beds, 13-29% of hospitals sized ≥100 beds reported not havening one infection control nurse. Since based on the number of beds in larger institutions or in facilities caring for high-risk patients several infection control nurses may be required, the deficiency in infection control nurses may even be higher, particularly in secondary and tertiary care facilities. Furthermore, the analysis revealed that the legal requirements for surveillance and reporting of notifiable infectious diseases have not yet been implemented in 11% of the facilities. The implementation of antibiotic strategies did show significant gaps. However, deficiencies in the implemented measures for the prevention of surgical site infections were less frequent. Yet 12% of the participants did not have a dedicated infection control concept for their surgical services. Eight percent of hospitals were not prepared for an outbreak management and 10% did not have established regulations for wearing surgical scrubs. Deficiencies in waste disposal and the control of air-conditioning systems were also noted. Based on the results of this survey, conclusions on the optimal resource allocation for further improvement of patient safety may be drawn. While all participating nursing homes had
Begley, Cecily M; Glacken, Michèle
Stress and bullying have been found to be common problems in a number of studies of Irish nursing and midwifery. Victims of bullying need high levels of assertiveness to enable them to withstand the stress of victimization. It was deemed important to measure nursing students' level of assertiveness prior to, and near completion of, their pre-registration education programme. Aim. To ascertain nursing students' perceived levels of assertiveness prior to, and nearing the completion of, their three-year pre-registration programme. Ethical approval was given. The students commencing general nurse education programmes in two schools in Southern Ireland agreed to take part (n=72). A questionnaire adapted from a number of assertiveness scales, and tested for validity and reliability in this population, was used to collect data. In general, students' reported assertiveness levels rose as they approached completion of their three-year education programme. The resource constrained health service of the 21st century requires nurses who are assertive to meet the needs of its users. Nursing students' assertiveness skills could be augmented through concentrated efforts from nurse educationalists and clinicians to reduce the communication theory practice gap in nurse education today. To address the multi-dimensional nature of assertiveness, strategies to increase assertiveness should operate at the individual, interface and organisational level. The students in this study reported an increase in levels of assertiveness as they approached completion of their three-year education programme. To function as effective, safe practitioners registered nurses need to be assertive, therefore education in assertiveness should be an integral part of their preparation. The precise composition and mode of delivery of this education requires exploration and evaluation.
Kovner, Christine T; Brewer, Carol; Katigbak, Carina; Djukic, Maja; Fatehi, Farida
To improve patient outcomes and meet the challenges of the U.S. health care system, the Institute of Medicine recommends higher educational attainment for the nursing workforce. Characteristics of registered nurses (RNs) who pursue additional education are poorly understood, and this information is critical to planning long-term strategies for U.S. nursing education. To identify factors predicting enrollment and completion of an additional degree among those with an associate or bachelor's as their pre-RN licensure degree, we performed logistic regression analysis on data from an ongoing nationally representative panel study following the career trajectories of newly licensed RNs. For associate degree RNs, predictors of obtaining a bachelor's degree are the following: being Black, living in a rural area, nonnursing work experience, higher positive affectivity, higher work motivation, working in the intensive care unit, and working the day shift. For bachelor's RNs, predictors of completing a master's degree are the following: being Black, nonnursing work experience, holding more than one job, working the day shift, working voluntary overtime, lower intent to stay at current employer, and higher work motivation. Mobilizing the nurse workforce toward higher education requires integrated efforts from policy makers, philanthropists, employers, and educators to mitigate the barriers to continuing education.
Edna Johana Mondragón-Sánchez; Erika Alejandra Torre Cordero; María de Lourdes Morales Espinoza; Erick Alberto Landeros-Olvera
OBJECTIVE: to compare the level of fear of death in nursing students and professionals. METHOD: this was a comparative-transversal study examining 643 nursing students and professionals from a third-level institution. A random sampling method was employed, and the sample size was calculated by power analysis. The study was developed during three stages: the first stage consisted of the application of a pilot test, the second stage involved the recruitment of the participants, and the third st...
This article reviews why nursing operations automation is important, reviews the impact of computer technology on nursing from a historical perspective, and considers the future of nursing operations automation and health care technology innovations in 2025 and beyond. The increasing automation in health care organizations will benefit patient care, staffing and scheduling systems and central staffing offices, census control, and measurement of patient acuity.
Yildiz Findik, Ummu; Ozbas, Ayfer; Cavdar, Ikbal; Yildizeli Topcu, Sacide; Onler, Ebru
The aim of this study was to evaluate the stress levels and stress coping strategies of nursing students in their first operating room experience. This descriptive study was done with 126 nursing students who were having an experience in an operating room for the first time. Data were collected by using Personal Information Form, Clinical Stress Questionnaire, and Styles of Coping Inventory. The nursing students mostly had low clinical stress levels (M = 27.56, SD = 10.76) and adopted a self-confident approach in coping with stress (M = 14.3, SD = 3.58). The nursing students generally employed a helpless/self-accusatory approach among passive patterns as their clinical stress levels increased, used a self-confident and optimistic approach among active patterns as their average age increased, and those who had never been to an operating room previously used a submissive approach among passive patterns. The results showed that low levels of stress caused the nursing students to use active patterns in coping with stress, whereas increasing levels of stress resulted in employing passive patterns in stress coping. The nursing students should be ensured to maintain low levels of stress and use active patterns in stress coping.
Full Text Available Background and Objective : Triage is essential for classification of patients in order to providing the best treatment and their transport to medical centers. The concordance of triage level between emergency medical technicians and triage nurses increases the accuracy and reduce of delivery time of patients, however the results of some studies demonstrated the poor triage of patients. This study was conducted aimed to determine the overall concordance of triage level between emergency medical technicians, triage nurses and instructor. Materials and Method: In this descriptive study, one instructor, 5 triage nurses and 30 emergency medical technicians participated through census in Iranshahr in 2014. Data collection tools were the demographic information form and “Emergency Severity Index" triage form. 78 patients were triaged separately by emergency medical technicians, triage nurses and instructor (as criteria. The overall concordance was assessed by kappa coefficient using SPSS 16. Results: The Kappa coefficient about the overall concordance of triage between emergency medical technicians and triage nurses was 0.20, between emergency medical technicians and instructor was 0.10 and between triage nurse and instructor was 0.19 Conclusion: According to the results, the overall concordance in triage level between triage nurse, emergency medical technicians and instructor was poor. Therefore, triage training courses and implementation of common triage is suggested for increase the agreement rate and reduce the time of patient transfer.
Gómez-Urquiza, Jose L; Monsalve-Reyes, Carolina S; San Luis-Costas, Concepción; Fernández-Castillo, Rafael; Aguayo-Estremera, Raimundo; Cañadas-de la Fuente, Guillermo A
To determine the risk factors and levels of burnout in Primary Care nurses. A systematic review was performed. CINAHL, CUIDEN, LILACS, PubMed, ProQuest, ScienceDirect and Scopus databases were consulted. Search equations were 'burnout AND community health nursing' and 'burnout AND primary care nursing'. The search was performed in October 2015. The final sample was n=12 studies. Quantitative primary studies that used Maslach Burnout Inventory for burnout assessment in Primary Care nurses were included without restriction by publication date. The main variables were the mean and standard deviation of the three burnout dimensions, high, medium and low prevalence rates of each dimension, and socio-demographic, occupational and psychological variables that potentially influence burnout level. Studies show high prevalence rates, generally between 23% and 31%, of emotional exhaustion. The prevalence rates of high depersonalisation and low personal accomplishment show heterogeneity, varying between 8%-32% and 4%-92% of the sample, respectively. Studies show that older nurses with more seniority, anxiety and depression, among other variables, have higher burnout levels, while nurses with higher salary, high job satisfaction, organisational support, and good self-concept have less burnout. High emotional exhaustion is the main affected dimension of burnout in Primary Care nursing. There is heterogeneity in depersonalisation and personal accomplishment. Burnout must be prevented in these professionals, by increasing protective factors and monitoring its appearance in those with risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
The Human Resources Staffing Plan quantified the equivalent staffing needs required for the Tank Farm Contractor (TFC) and its subcontractors to execute the readiness to proceed baseline between FY 2000-2008. The TFC staffing needs were assessed along with the staffings needs of Fluor Hanford and the privatization contractor. The plan then addressed the staffing needs and recruitment strategies required to execute the baseline.
Baisch, Mary Jo
Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.
Labrague, L J; McEnroe-Petitte, D M; Gloe, D; Tsaras, K; Arteche, D L; Maldia, F
This is a research report examining the influence of organizational politics perceptions on nurses' work outcomes (job satisfaction, work stress, job burnout and turnover intention). Organizational politics is a phenomenon common in almost all institutions and is linked with undesirable consequences in employees. Despite the plethora of research around the world on this topic, studies describing organizational politics in nursing remain underexplored. A cross-sectional research design was utilized in this study. One hundred sixty-six (166) nurses participated. Five standardized tools were used: the Job Satisfaction Index, the Job Stress Scale, the Burnout Measure Scale, the Turnover Intention Inventory Scale and the Perception of Organizational Politics Scale. Nurses employed both in private and government-owned hospitals perceived moderate levels of organizational politics. Positive correlations were identified between perceived organizational politics and job stress, turnover intention and job burnout. Negative correlations were found between perceived organizational politics and job satisfaction. Perceptions of workplace politics in Filipino nurses were lower when compared to findings in other international studies. A strong link was found between organizational politics perceptions and the four job outcomes (stress and burnout levels, turnover intention and job satisfaction). Use of a self-reporting questionnaire and exclusion of nurses from other provinces. Perceived organizational politics predicted nurses' stress and burnout levels, turnover intention and job satisfaction. The findings of this study may provide a valuable perspective of this organizational issue and could assist policymakers and nurse administrators in formulating interventions that could minimize the effect of workplace politics. © 2016 International Council of Nurses.
Stress among nurses leads to absenteeism, reduced efficiency, long-term health problems and a decrease in the quality of patient care delivered. A quantitative cross-sectional study was conducted. The study\\'s aim was to identify perceived stressors and influencing factors among nurses working in the critical and non-critical care practice areas. A convenience sample of 200 nurses were invited to complete the Bianchi Stress Questionnaire. Information was collected on demographics and daily nursing practice. Findings indicated that perceived stressors were similar in both groups. The most severe stressors included redeployment to work in other areas and staffing levels. Results from this study suggest that age, job title, professional experience and formal post-registration qualifications had no influence on stress perception. These results will increase awareness of nurses\\' occupational stress in Ireland.
experiencing significant change . It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure...culture, readiness, beliefs, and implementation. 15. SUBJECT TERMS Evidence-based practice, culture, mentor, organizational change 16. SECURITY...Medical Command; her areas of interest include staffing, acuity, nursing workload, change management, organizational culture and empowering junior
Nayback-Beebe, Ann M; Forsythe, Tanya; Funari, Tamara; Mayfield, Marie; Thoms, William; Smith, Kimberly K; Bradstreet, Harry; Scott, Pamela
In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.
Objective: To survey the level of psychological capital among nurses, investigating influencing factors of psychological capital. Methods-. 97 clinical nurses from 3A -level hospital of traditional Chinese medicine were recruited and investigated with Psychological Capital Questionnaire (PCQ) and General Information Questionnaire. Results:Resiliency level of nurses in massage department was higher than in acupuncture department. Stepwise multiple regression analysis showed that professional titles and staffing situation were significant predictors of psychological capital among nurses from the 3 A - level hospital of traditional Chinese medicine. Conclusion: Nursing managers should pay more attention to the level of resiliency among nurses, and to take appropriate measures to improve the level of psychological capital among nurses and to promote the development of the nursing profession.%目的:调查护士心理资本状况,探讨心理资本的影响因素.方法:采用一般资料问卷和心理资本问卷对某三级甲等中医院97名针灸科和推拿科护士进行问卷调查.结果:推拿科护士韧性水平高于针灸科护士.多元逐步回归分析显示,职称和人员配备状况是中医院护士心理资本的重要影响因素.结论:护理管理者应重视针灸科护士的韧性水平,采取相应措施提高护士心理资本水平,以提高护理事业的发展.
Murdock, Calla; Naber, Jessica; Perlow, Michael
The purpose of this study was to review the stress levels and the stress management skills of admitted baccalaureate nursing students at a rural public university. Subjects completed a questionnaire to estimate stress levels, causes of stress, stress management skills, and the use of stress management skills. Stress levels by gender and group were compared using analysis of variance (ANOVA). No significant differences in stress levels by semester were discovered. A significant difference was discovered when stress levels were compared by gender. Subjects also responded that students should be taught stress management skills upon admission into the program. Additionally, stress management skills should be reinforced each semester to help students identify causes and better manage their stress. Research in the area of stress and nursing students has been sporadically attempted through the years. However, focus on stress, gender, and program placement is far less evident. The purpose of this study was to answer the following research question: What are the stress levels and the stress management skills of baccalaureate nursing students? To that end, a questionnaire was developed to identify the stress and stress management skills of the baccalaureate nursing students with the results analyzed for frequency and percentages. This study looked not only at the stress levels and stress management skills of the baccalaureate nursing student, but also took into account the subject's gender and program placement.
Arslan Yurumezoglu, Havva; Kocaman, Gulseren
Because of the nursing shortage problem, an important goal for nurse managers is preventing nurses from leaving the organization. This study analyzed the effect of evidence-based nursing management practices on nurses' levels of job satisfaction, organizational commitment, and intent to leave using the Promoting Action Research Implementation in Health Service framework as a guide. This study employed a single-group, quasi-experimental, pretest-post-test design with repeated measures. Data were collected using the Minnesota Job Satisfaction Questionnaire and the Organizational Commitment Scale. The study was conducted at a 127-bed private, accredited hospital. The sample was composed of 58 nurses who participated in all three measurements. Data analysis was conducted using repeated-measures anova and the Cochrane Q-test. An improvement was observed in the nurses' intrinsic, extrinsic, and total satisfaction levels, and in the degree of normative commitment. Nurse managers stated that they benefited from this study. In order to find effective and long-lasting solutions to the nursing shortage problem, evidence-based recommendations should be used in nursing management.
Villeneuve, Michael J
Nurses in the 21st century are being called to rise to new levels of practice, including a more influential leadership at senior levels of policy development. Decades of research, good will, and a revolutionary civil rights movement have not resolved the world's staggering health outcome disparities. Nursing has a solution: Many of the most troubling disparities are amenable to effective intervention by the world's nurses through their clinical and policy work. The author challenges nurses to imagine the impact on global health if the elimination of disparities is the core goal of nursing for the 21st century. Moving from individuals and communities to systems levels, nurses must be versed in a range of system-level vital signs that affect policy development including economics, demographics, and access to care. Setting our sights on the elimination of health disparities offers a rallying point around which nursing can coalesce and set human health on a new and more equitable course.
Full Text Available Chenjuan Ma,1 Jingjing Shang,2 Patricia W Stone3 1The National Database of Nursing Quality Indicators, University of Kansas Medical Center, Kansas City, KS, 2Columbia University School of Nursing, 3Center for Health Policy, Columbia University School of Nursing, New York, NY, USA Background: Readmissions have been targeted as events that can improve quality of care while reducing health care expenditures. While increasing evidence has linked nurse work environment to various patient outcomes, no systematic review has assessed evidence examining nurse work environment in relation to readmission. Methods: This review was guided by the Institute of Medicine's Standards for Systematic Reviews. Comprehensive searches were conducted in PubMed, CINAHL, and PsycINFO, and were complemented by hand searching. Two reviewers independently completed full-text review and quality assessment using a validated tool. Results: Ten studies met the inclusion criteria and were included for final review. Various methods were used to measure readmission and nurse work environment, and analyses were conducted at both the patient and hospital levels. Overall, associations between nurse work environment and readmission emerged, and better nurse work environments (particularly higher levels of nurse staffing were associated with fewer readmissions. Discussion: The interpretation of results from each study was limited by the differences in variable measures across studies and methodological flaws. The relationship between nurse work environment and readmission needs to be further confirmed by stronger evidence from studies using standardized measures and more rigorous research design. Keywords: nurse work environment, nurse staffing, readmission, nursing, patient outcome
Kerlin, Meeta Prasad; Adhikari, Neill K J; Rose, Louise; Wilcox, M Elizabeth; Bellamy, Cassandra J; Costa, Deena Kelly; Gershengorn, Hayley B; Halpern, Scott D; Kahn, Jeremy M; Lane-Fall, Meghan B; Wallace, David J; Weiss, Curtis H; Wunsch, Hannah; Cooke, Colin R
Studies of nighttime intensivist staffing have yielded mixed results. To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models. Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95% confidence interval, 0.75-1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes. Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.
Li, Yue; Li, Qinghua; Tang, Yi
Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: -.01 to -.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes.
Gandi, Joshua C; Wai, Paul S; Karick, Haruna; Dagona, Zubairu K
Nurses' empathy for and connection with patients demonstrates core professional values which are essential but, consequently, attract certain factors capable of inducing stress. Studies of the roles and responsibilities associated with nursing have implicated multiple and conflicting demands which might not be without some resultant effects. However, little research has been conducted on these work characteristics in developing economies to determine how these might impact the nurse employees' performance. There is need for evidence-based empirical findings to facilitate improvement in healthcare services. This study examined stress and level of burnout among Nigerian nurses (n = 2245) who were selected using stratified random sampling. The participants were measured using an 'abridged measures booklet' adopted from the Maslach Burnout Inventory-General Survey (MBI-GS), Job Autonomy Questionnaire (JAQ), Questionnaire on Organisational Stress-Doetinchem (VOS-D) and Job Diagnostic Survey (JDS). The roles of work-home interference (WHI) and home-work interference (HWI), with respect to work characteristics and burnout (paying special attention to gender), were examined. Analyses using t-tests and linear regression showed no gender differences in burnout levels among Nigerian nurses, who experience medium to high levels of emotional exhaustion, medium levels of depersonalisation and high levels of personal accomplishment. WHI and HWI were found to mediate the relationship between work characteristics and burnout. The meditational relationship differs between genders. This study calls for further research into gender and burnout among the caring professions, especially in under-developed and developing economies of the world.
Mª Cristina Pascual Fernández
Full Text Available When the patients are in the end-of-life, the cares would focus to favor a good death, for that reason the nursing staff must know how to integrate the death like a part of the life, being avoided that produces anxiety to them before the possibility of taking part its own fears to the death. The core of nursing staff in intensive care units is to maintain life of their patients, reason why the end-of life in them is not easy or natural.Objective: Evaluate the death anxiety levels in intensive care nursing staff.Material and method: An observational study was conducted descriptive cross hospital adult and Paediatric ICU General University Gregorio Marañón Hospital, through survey to nurses and auxiliary nurses of those units.The anxiety inventory was used to Death (Death Anxiety Inventory [DAI] for the assessment of anxiety before death. Outcomes: Paediatric ICU nurses have higher levels of anxiety that the adult ICU as well as the less experienced professionals and those declared not feel trained in the subject.Conclusions: Experience and the training are key elements that help professionals face to death, from management we must ensure that patients in stage terminal are served by professionals with this profile.
Yang, Jun; Guo, Aimin; Wang, Yadong; Zhao, Yali; Yang, Xinhua; Li, Hang; Duckitt, Roger; Liang, Wannian
We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future. A study questionnaire was completed by 712 CHS organizations distributed in 52 cities and districts in all areas of China using a multilevel stratified randomized sampling method. Data were collected on the backgrounds, human resources, and service functions of CHS organizations. We found that 68.2% of doctors and 86.5% of nurses employed in CHS centers have low-level medical training. The doctor-nurse ratio in CHS centers is 1.2 to 1 and in CHS stations is 1.3 to 1. More than 50% of CHS organizations have developed on-the-job training programs, causing cost trends for staff training to increase. Although the delivery of basic clinical services and public health services is steadily increasing, 58.6% of stations are open less than 12 hours per day. Health records are established in a high proportion of CHS organizations. Two kinds of health education--general public health education, and personal education for specific problems--have been adopted by more than 92% of CHS centers and 90% of CHS stations. Desired functions for CHS organizations have been partially achieved. Training for doctors and nurses engaged in CHS should be promoted and improved as quickly as possible. Training in basic clinical services and management of noncommunicable chronic diseases should be strongly promoted. Changes in government policies should be pursued to promote effective support for the development of CHS.
Harrington, Charlene; Ross, Leslie; Kang, Taewoon
The study examined the ownership transparency, financial accountability, and quality indicators of a regional for-profit nursing home chain in California, using a case study methodology to analyze data on the chain's ownership and management structure, financial data, staffing levels, deficiencies and complaints, and litigation. Secondary data were obtained from regulatory and cost reports and litigation cases. Qualitative descriptions of ownership and management were presented and quantitative analyses were conducted by comparing financial and quality indicators with other California for-profit chains, for-profit non-chains, and nonprofit nursing home groups in 2011. The chain's complex, interlocking individual and corporate owners and property companies obscured its ownership structure and financial arrangements. Nursing and support services expenditures were lower than nonprofits and administrative costs were higher than for-profit non-chains. The chain's nurse staffing was lower than expected staffing levels; its deficiencies and citations were higher than in nonprofits; and a number of lawsuits resulted in bankruptcy. Profits were hidden in the chain's management fees, lease agreements, interest payments to owners, and purchases from related-party companies. Greater ownership transparency and financial accountability requirements are needed to ensure regulatory oversight and quality of care.
Payson, A A
The traditional method of apportioning nursing care costs ona per diem basis does not consider nursing intensity or patients' special needs and often includes nonnursing duties. Many hospitals now favor a fee-for-service concept and are determining direct patient care costs to identify the true nursing cost. A patient classification system correlated with the diagnosis-related group (DRG) classification improves nursing cost analyses. For each patient, nurse managers need systems to determine quantified nursing tasks and patient acuity levels for each day. This information can be used to adjust staffing and to establish variable billing procedures. Then they can institute variable billing methods that are based on direct care costs as well as indirect costs of administration, education, and supplies. Variable billing identifies revenue cost centers, allows systematic monitoring of nursing services, and improves budget planning. The entire nursing staff must become involved in the financial system so the hospital can obtain an accurate data base for rate setting and third-party reimbursement.
A number of studies of nursing and midwifery have found stress and bullying to be frequent problems. Those suffering from bullying and stress need to have high levels of assertiveness to resist and to cope successfully. Hence, it was considered vital to assess the assertiveness level of nursing students throughout their training curriculum. The study population was composed of nursing students in different semesters at one school in Central Greece (n=298) who agreed to complete a questionnaire on assertiveness level assessment, which had been translated into Greek and adapted to this population. All students present in class completed the questionnaire, representing 80% of the total population of active students. Mean assertiveness scores between semesters were compared by ANOVA and comparisons between the responses of the first semester students and responses of advanced semester students were done by Pearson's chi square. The main finding of this study was that the assertiveness levels displayed by students increase slightly in advanced semesters by comparison to those displayed by first-semester students. Assertive behavior should be encouraged through learning methods. Nurses should preferably obtain this training throughout their studies. Instructors have an essential role in the improvement and achievement of assertiveness training curriculums for undergraduate nursing students.
Brunault, Paul; Fouquereau, Evelyne; Colombat, Philippe; Gillet, Nicolas; El-Hage, Wissam; Camus, Vincent; Gaillard, Philippe
Improvement in nurses' quality of work life (QWL) has become a major issue in health care organizations. We hypothesized that the level of transactive memory (defined as the way groups collectively encode, store, and retrieve knowledge) and participative teamwork (an organizational model of care based on vocational training, a specific service's care project, and regular interdisciplinary staffing) positively affect nurses' QWL. This cross-sectional study enrolled 84 ward-based psychiatric nurses. We assessed transactive memory, participative teamwork, perceived organizational justice, perceived organizational support, and QWL using psychometrically reliable and valid scales. Participative teamwork and transactive memory were positively associated with nurses' QWL. Perceived organizational support and organizational justice fully mediated the relationship between participative teamwork and QWL, but not between transactive memory and QWL. Improved transactive memory could directly improve nurses' QWL. Improved participative teamwork could improve nurses' QWL through better perceived organizational support and perceived organizational justice.
Lee, Ya-Wen; Dai, Yu-Tzu; Park, Chang-Gi; McCreary, Linda L
The purpose of this study was to explore the relationship between quality of work life (QWL) and nurses' intention to leave their organization (ITLorg). A descriptive cross-sectional survey design was conducted using purposive sampling of 1,283 nurses at seven hospitals in Taiwan. Data were collected from March to June 2012. Three questionnaires, including the Chinese version of the Quality of Nursing Work Life scale (C-QNWL), a questionnaire of intention to leave the organization, and a demographic questionnaire, with two informed consent forms were delivered to the nurses at their workplaces. Descriptive data, Pearson's correlations, and the ordinal regression model were analyzed. Over half (52.5%) of nurses had ITLorg. Seven QWL dimensions were significantly negatively correlated with ITLorg (r = -0.17 to -0.37, p working in a nonteaching hospital. Four of the QWL dimensions--supportive milieu with job security and professional recognition, work arrangement and workload, work or home life balance, and nursing staffing and patient care--were also predictors of ITLorg. Three QWL dimensions were not predictors of ITLorg. This study showed that individual-related variables (being single, having a diploma or lower educational level), a work-related variable (working at a nonteaching hospital), and the four QWL dimensions play a significant role in nurses' ITLorg. After the QWL dimensions were added to the regression, the variance explained by the model more than doubled. To reduce nurses' ITLorg, nursing administrators may offer more focused interventions to improve the supportive milieu with job security and professional recognition, work arrangement and workload, work or home life balance, and nursing staffing and patient care. © 2013 Sigma Theta Tau International.
José Ricardo Ferreira da Fonseca
Full Text Available The study aimed to identify stress levels, areas and their activities identified as stressful by nurses working in the emergence in Manaus, AM, Brazil. It is an epidemiological, cross-sectional design, with 36 emergency nurses from December 2010 to January 2011. The Bianchi Stress Scale with 57 questions was used. The nurses were at risk for high levels of stress. The most stressful areas were the operation of the unit, conditions of work and personnel administration, and the most stressful activity was the request for equipment review and repair. The difference by Friedman test between the areas was significant (p <0.05, Dunn post-test significant (p <0.05 when compared by peers. The accumulation of management activities with the assistance activities can generate higher levels of stress, it is necessary to invest in improving the work environment and management support to minimize the stress experienced at work.
O'Neill, Thomas R; Tannenbaum, Richard J; Tiffen, Jennifer
When nurses who are educated internationally immigrate to the United States, they are expected to have English language proficiency in order to function as a competent nurse. The purpose of this research was to provide sufficient information to the National Council of State Boards of Nursing (NCSBN) to make a defensible recommended passing standard for English proficiency. This standard was based upon the Test of English as a Foreign Language (TOEFL). A large panel of nurses and nurse regulators (N = 25) was convened to determine how much English proficiency is required to be minimally competent as an entry-level nurse. Two standard setting procedures, the Simulated Minimally Competent Candidate (SMCC) procedure and the Examinee Paper Selection Method, were combined to produce recommendations for each panelist. In conjunction with collateral information, these recommendations were reviewed by the NCSBN Examination Committee, which decided upon an NCSBN recommended standard, a TOEFL score of 220. Because the adoption of this standard rests entirely with the individual state, NCSBN has little more to do with implementing the standard, other than answering questions and providing documentation about the standard.
The descriptively designed study was conducted in order to determine academic nurses' job satisfaction levels, intention of leaving job and effective reasons. The study was implemented in 10 nursing schools offering postgraduate and doctoral education in Turkey, and data was collected from academics working in these schools who agreed to participate in the study. After obtaining the required approval from the ethics committees and institutional permissions, data was collected from 248 academic nurses using a personal information form and a "Job Satisfaction Scale" between June 2009 and January 2010. The data was analyzed by frequency and percentage distribution, using Cronbach's Alpha coefficient, ANOVA, Qui-Square and Tukey's HSD test for advanced analysis methods with SPSS 11.5 statistics packet software. This study concludes that academic nurses are moderately satisfied with their jobs. In addition, job satisfaction was found to be lower among research assistants, assistant professors, nurses with less than 10 years of academic experience, nurses who have completed their doctorate dissertations, or who are working on appointment or contract basis. © 2013. Published by Elsevier Ltd. All rights reserved.
Amelsvoort, van H.W.C.H. Gonnie; Hendriks, Maria A.; Scheerens, Jaap
International comparisons of indicators on staffing are regarded as a useful information base to policymakers. Politically relevant staffing indicators in relation to the costs, planning and quality of education deal with training, working conditions, staff characteristics, and stability and mobilit
van Amelsvoort, H.W.C.H.; Hendriks, Maria A.; Scheerens, Jaap
International comparisons of indicators on staffing are regarded as a useful information base to policymakers. Politically relevant staffing indicators in relation to the costs, planning and quality of education deal with training, working conditions, staff characteristics, and stability and
Specht, Jennifer A
This study explored the effect of mentoring on the levels of role conflict and role ambiguity experienced by novice nursing faculty related to their transitions into academe using a descriptive, comparative design. It also measured the relationship between the quality of mentoring experiences of novice nursing faculty and their levels of role conflict and role ambiguity using a correlational design. P. Benner's (1984) novice to expert model was utilized as a framework for successful role transition. J. R. Rizzo, R. J. House, and S. I. Lirtzman's (1970) role conflict and role ambiguity scale was used to measure the levels of role conflict and role ambiguity experienced by novice nursing faculty. Results indicate that participants (n = 224) who were mentored have significantly lower levels of role conflict (M = 3.57) and role ambiguity (M = 3.02) than those who were not mentored (M = 4.62 and M = 3.90, respectively). Also significant, the higher the participants' reported levels of quality of mentoring experiences were, the lower their levels of role conflict and role ambiguity were. The results of this study indicate that mentoring eases the transition of novice nursing faculty from practice into academe by decreasing the degree of role ambiguity and role conflict that they experience.
Ramli, Razamin; Tein, Lim Huai
A good work schedule can improve hospital operations by providing better coverage with appropriate staffing levels in managing nurse personnel. Hence, constructing the best nurse work schedule is the appropriate effort. In doing so, an improved selection operator in the Evolutionary Algorithm (EA) strategy for a nurse scheduling problem (NSP) is proposed. The smart and efficient scheduling procedures were considered. Computation of the performance of each potential solution or schedule was done through fitness evaluation. The best so far solution was obtained via special Maximax&Maximin (MM) parent selection operator embedded in the EA, which fulfilled all constraints considered in the NSP.
Jiang, Hui; Li, Chen; Gu, Yan; He, Yanan
There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. Identify the perceptions and practice of physical restraint in China. This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. A total of 18 nurses were interviewed and 330 nurses were surveyed. Approval of the study was obtained from the hospital ethics committee. Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. Physical restraint was commonly used to protect patients' safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses (p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China. © The Author(s) 2014.
Bjarnadottir, Ragnhildur I; Herzig, Carolyn T A; Travers, Jasmine L; Castle, Nicholas G; Stone, Patricia W
While electronic health records have emerged as promising tools to help improve quality of care, nursing homes have lagged behind in implementation. This study assessed electronic health records implementation, associated facility characteristics, and potential impact on quality indicators in nursing homes. Using national Centers for Medicare & Medicaid Services and survey data for nursing homes, a cross-sectional analysis was conducted to identify variations between nursing homes that had and had not implemented electronic health records. A difference-in-differences analysis was used to estimate the longitudinal effect of electronic health records on commonly used quality indicators. Data from 927 nursing homes were examined, 49.1% of which had implemented electronic health records. Nursing homes with electronic health records were more likely to be nonprofit/government owned (P = .04) and had a lower percentage of Medicaid residents (P = .02) and higher certified nursing assistant and registered nurse staffing levels (P = .002 and .02, respectively). Difference-in-differences analysis showed greater quality improvements after implementation for five long-stay and two short-stay quality measures (P = .001 and .01, respectively) compared with those who did not implement electronic health records. Implementation rates in nursing homes are low compared with other settings, and better-resourced facilities are more likely to have implemented electronic health records. Consistent with other settings, electronic health records implementation improves quality in nursing homes, but further research is needed to better understand the mechanism for improvement and how it can best be supported.
Sherman, V. Clayton
The report describes a study designed to analyze nurses' management duties and to identify their tasks in planning, organizing, staffing. leading, communication, decision making, and controlling. A total of 117 supervisory nurses and unit managers from four Western Michigan short-term general hospitals in the 410-540 bed range participated in the…
McPhail, Ruth; Fisher, Ron; Harvey, Michael; Moeller, Miriam
This article explores the evolution of international staffing in an increasingly globalized and hypercompetitive marketplace. As the issue of staff retention becomes critical in global organizations, it is important to understand the types of managers that may be on or assigned to overseas assignments. The purpose of this article is to present a…
Kim, Youngsang; Ployhart, Robert E
This study integrates research from strategy, economics, and applied psychology to examine how organizations may leverage their human resources to enhance firm performance and competitive advantage. Staffing and training are key human resource management practices used to achieve firm performance through acquiring and developing human capital resources. However, little research has examined whether and why staffing and training influence firm-level financial performance (profit) growth under different environmental (economic) conditions. Using 359 firms with over 12 years of longitudinal firm-level profit data, we suggest that selective staffing and internal training directly and interactively influence firm profit growth through their effects on firm labor productivity, implying that staffing and training contribute to the generation of slack resources that help buffer and then recover from the effects of the Great Recession. Further, internal training that creates specific human capital resources is more beneficial for prerecession profitability, but staffing is more beneficial for postrecession recovery, apparently because staffing creates generic human capital resources that enable firm flexibility and adaptation. Thus, the theory and findings presented in this article have implications for the way staffing and training may be used strategically to weather economic uncertainty (recession effects). They also have important practical implications by demonstrating that firms that more effectively staff and train will outperform competitors throughout all pre- and postrecessionary periods, even after controlling for prior profitability.
João Francisco Possari
Full Text Available Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC, during the transoperative period at a surgical center specializing in oncology.Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing technicians from patient reception who worked in the surgical center during the transoperative period. An instrument was developed to collect data and the interventions were validated according to NIC taxonomy.Results: a total of 266 activities were identified and mapped into 49 nursing interventions, seven domains and 20 classes of the NIC. The most representative domains were Physiological-Complex (61.68% and Health System (22.12%, while the most frequent interventions were Surgical Care (30.62% and Documentation (11.47%, respectively. The productivity of the nursing team reached 95.34%.Conclusions: use of the Nursing Intervention Classification contributes towards the discussion regarding adequate, professional nursing staffing levels, because it shows the distribution of the work load.
Full Text Available Brett Williams,1 Ted Brown,2 Malcolm Boyle,1 Lisa McKenna,3 Claire Palermo,4 Jamie Etherington1 1Department of Community Emergency Health and Paramedic Practice, 2Department of Occupational Therapy, 3School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University–Peninsula Campus, Frankston, 4Department of Nutrition and Dietetics, Faculty of Medicine, Nursing and Health Sciences, Monash University–Berwick Campus, Berwick, Vic, Australia Purpose: This research examines the extent and nature of empathy among emergency health (paramedic, nursing, and midwifery students at one Australian university and investigates the longitudinal changes in empathy levels across the course of study. Methods: First-, second-, and third-year students at Monash University completed the Jefferson Scale of Empathy–Health Professional (JSE-HP in 2008, 2009, and 2010, and the resulting mean empathy scores were analyzed by course, year of course, year of study, age, and sex. Results: Midwifery students were found to have higher empathy levels than nursing and emergency health students. Second- and third-year students scored higher than their counterparts in the first year. Empathy levels dipped in 2009 and rose in 2010. Students aged 26–30 years and 31–35 years recorded higher scores than their younger colleagues, and female students were found to be more empathic than their male counterparts. Conclusion: The finding that empathy levels are relatively stable over the term of study contributes to the understanding of how empathy evolves over the course of study and offers insights into the importance of incorporating and promoting empathy in health care curricula. Keywords: empathy, nursing, paramedics, midwifery, undergraduates
Maria Cecilia Pires da Rocha
Full Text Available The present study evaluates the use of salivary cortisol concentration as a physiological index of the stress level among nurses on their work day and day off and correlates it with the questionnaire used to measure occupational stress in nurses (Inventário de Estresse em Enfermeiros - IEE. This is a comparative, cross-sectional descriptive study in which sociodemographic data, IEE results and salivary cortisol levels were used. Fifty-seven nurses participated in the study (80.7% females and a mean age of 37.1 years old. The IEE average score was 124.5. The average cortisol level was 564.1 ng/m on work day and 354.1 ng/mL on day off. Nurses who had double workdays presented high values of salivary cortisol during the work day (638.1 ng/mL. In conclusion, salivary cortisol identified the nurses’ stress level, and differences were found between a work day and day off. On the nurses’ day off, their salivary cortisol levels and stress scores were lower.
Morse, Ben W.; Piland, Richard N.
Found statistically significant differences across the three relationships for the importance of communication skills such as listening, routine information exchange, management of conflict, small group communication, etc. This study allows speech communication instructors to articulate the competencies needed by nurses across relationships. (PD)
Dixon, Mark R.; Nastally, Becky L.; Waterman, Amber
The current study evaluated the effect of participating in simulated gambling activities on happiness levels of 3 nursing home residents. A 4-component analysis was used to measure objective responses associated with happiness during baseline, varying durations of engagement in simulated gambling activities, and 2 follow-up periods. Results…
Full Text Available Objective: Job stress and burnout levels of oncology nurses increase day-by-day in connection with rapidly increasing cancer cases worldwide as well as in Turkey. The purpose of this study was to establish job stress and burnout levels of oncology nurses and the relationship in between. Methods: The sample of this descriptive study comprised of 189 nurses that are selected by nonprobability sampling method, employed by 11 hospitals in Istanbul. Survey form of 20 questions, Job Stressors Scale and Maslach Burnout Inventory (MBI were used during collection of data. Data were evaluated using percentage, Kruskal-Wallis, Mann-Whitney U and Spearman correlation analyses. Results: In the study, there was a positively weak correlation between "Work Role Ambiguity" subdimension of Job Stressors Scale and "Emotional Exhaustion" and "Personal Accomplishment" subdimensions, whereas a positively weak and medium correlation was encountered between "Work Role Conflict" subdimension and "Emotional Exhaustion" and "Depersonalization" subdimensions. A negatively weak correlation was found between "Work Role Overload" subdimension and "Emotional Exhaustion" and "Depersonalization" subdimensions. Conclusion: A significant relationship was established between subdimensions of job stress level and of burnout level, that a lot of oncology nurses who have participated in the study wanted to change their units, because of the high attrition rate.
Grönstedt, Helena; Hellström, Karin; Bergland, Astrid
The main aim of this study was to describe physical and cognitive function and wellbeing among nursing home residents in three Nordic countries. A second aim was to compare groups of differing ages, levels of dependency in daily life activities (ADL), degree of fall-related self-efficacy, wellbeing...... and cognitive function....
Chu, Christine; Perkins, Andrew; Marks-Maran, Di
This paper explores the development, delivery and evaluation of a pilot programme in academic literacy skills to help students make the transition from year 1 of their undergraduate nursing programme (level 4) to year 2 (level 5). Although there is a good deal of literature available about supporting students in year 1 to develop academic literacy skills, there is a dearth of literature on supporting students as they move from level to level during their university programmes. The pilot programme comprised five 1½ hr sessions on different aspects of literacy skills in the transition period between year 1 and year 2. Students from one cohort were invited to participate on a voluntary basis. Students undertook a pre-test before starting the programme and a post-test at the end. However, only a small number chose to sit the post-test making comparative analysis impossible. However, results of the student questionnaires showed that student confidence in their literacy skills increased and their perceptions of their literacy skills were that they were improved as a result of the programme. Importantly, marks on semester 2 written assignments were improved compared with year 1 work for those who had attended the programme. This study is important for both the progression of students from year 1 to year 2 of their nursing programme and for their ability to develop the kinds of literacy skills required for nursing practice. Copyright Â© 2011 Elsevier Ltd. All rights reserved.
Matney, Susan A; Dolin, Gay; Buhl, Lindy; Sheide, Amy
A care plan provides a patient, family, or community picture and outlines the care to be provided. The Health Level Seven Consolidated Clinical Document Architecture (C-CDA) Release 2 Care Plan Document is used to structure care plan data when sharing the care plan between systems and/or settings. The American Nurses Association has recommended the use of two terminologies, Logical Observation Identifiers Names and Codes (LOINC) for assessments and outcomes and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for problems, procedures (interventions), outcomes, and observation findings within the C-CDA. This article describes C-CDA, introduces LOINC and SNOMED CT, discusses how the C-CDA Care Plan aligns with the nursing process, and illustrates how nursing care data can be structured and encoded within a C-CDA Care Plan.
Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine
Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.
This critical discourse analysis examines articles about the academic level of nurse education that appeared in British national newspapers between 1999 and 2009. British newspaper journalists regularly attribute problems with recruitment into nursing and nursing care to the increasing academic nature of nurse education. It is impossible to separate discourse about nurse education from the wider nursing discourse. Many journalists laud a traditional and stereotypical construct of nurse identity and suggest that increasing nurse education produces nurses who are 'too clever to care'. This article argues that whilst nurses lack a voice in the National press, they have little input into the construction of newspaper discourse about nurse education and subsequently, limited influence on resulting public opinion, government policy and the morale of nurses.
O'Brien-Pallas, Linda; Murphy, Gail Tomblin; Shamian, Judith; Li, Xiaoqiang; Hayes, Laureen J
As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units. Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses' intention to leave their positions. Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included. Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention. Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.
Hunker, Diane F; Gazza, Elizabeth A; Shellenbarger, Teresa
Because nursing care in health care settings becomes more complex, nurses are called upon to work effectively with other health care providers to deliver high-quality evidence-based care. To do so in a cost effective and efficient manner requires the development of effective oral and written communication skills in nurses. One form of written communication is scholarly writing. Scholarly writing is defined by the authors as writing that is specialized in nursing, communicates original thought, includes support from a body of literature, contains formal language consistent with the discipline of nursing, and is formatted in a manner consistent with peer-review publications. Faculty who facilitate the development of these skills face inconsistencies in students' writing ability and development across programs and levels of education. Nurse educators need to understand how to develop these communication skills for students enrolled at various educational levels and to teach students how to share information in a scholarly way.
Austin, Joan K; Kakacek, Jody R M; Carr, Deborah
This article presents a quantitative assessment of the impact of an epilepsy-focused training program on school nurses. The Epilepsy Foundation and the National Association of School Nurses (NASN) created a training program titled "Managing Students with Seizures" to educate school nurses on strategies and resources that they can use to handle emergency situations effectively and to create a safe and supportive school environment for children with epilepsy and seizures. Before and after the training sessions, nurses answered questionnaires that measured their confidence levels in providing care for students with epilepsy and seizures; these questionnaires showed an improvement in nurses' confidence levels across all measures. Analysis was also carried out to identify program components and nurse subgroups associated with statistically significant improvements. An evaluation of satisfaction indicated overall satisfaction with the program. This article presents results from 1,080 complete surveys associated with the training in 2007.
Specht, Jennifer A.
After an examination of the current issues related to the shortages of nurses and nursing faculty in the United States, the importance of facilitating the transition of interested nurse clinicians into their roles as nurse educators in order to address the decreased number of nurses and nursing faculty became apparent. Mentoring in nursing…
Masselink, Leah E; Daniel Lee, Shoou-Yih
During the past few decades, the nursing workforce has been in crisis in the United States and around the world. Many health care organizations in developed countries recruit nurses from other countries to maintain acceptable staffing levels. The Philippines is the centre of a large, mostly private nursing education sector and an important supplier of nurses worldwide, despite its weak domestic health system and uneven distribution of health workers. This situation suggests a dilemma faced by developing countries that train health professionals for overseas markets: how do government officials balance competing interests in overseas health professionals' remittances and the need for well-qualified health professional workforces in domestic health systems? This study uses case studies of two recent controversies in nursing education and migration to examine how Philippine government officials represent nurses when nurse migration is the subject of debate. The study finds that Philippine government officials cast nurses as global rather than domestic providers of health care, implicating them in development more as sources of remittance income than for their potential contributions to the country's health care system. This orientation is motivated not simply by the desire for remittance revenues, but also as a way to cope with overproduction and lack of domestic opportunities for nurses in the Philippines.
Temple, April; Dobbs, Debra; Andel, Ross
High turnover of nursing assistants (NAs) has implications for the quality of nursing home care. Greater understanding of correlates of NA turnover is needed to provide insight into possible retention strategies. This study examined nursing home organizational characteristics and specific job characteristics of staff in relation to turnover of NAs. Cross-sectional data on 944 nationally representative nursing homes were derived from the 2004 National Nursing Home Survey. Using a 3-month turnover rate, 25% of the facilities with the lowest turnover rates were classified as low turnover, 25% of the facilities with the highest turnover were classified as high turnover, and the remaining 50% of the facilities were classified as moderate turnover. Multinomial logistic regression was used to examine organizational and job characteristics associated with low and high turnover compared with moderate turnover. One organizational characteristic, staffing levels at or greater than 4.0 hours per patient day, was associated with greater odds of low NA turnover and reduced odds of high NA turnover. Job characteristics including higher wages and union membership were associated with greater odds of low NA turnover, whereas wages, fully paid health insurance, employee assistance benefits, and involvement in resident care planning were associated with reduced odds of high NA turnover. The results of this study suggest that job characteristics of NA staff may be particularly important for turnover. Specifically, the provision of competitive wages and benefits (particularly health insurance) and involvement of NAs in resident care planning could potentially reduce NA turnover, as could maintaining high levels of nurse staffing.
Min, Ari; Park, Chang Gi; Scott, Linda D
Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from LTCFocUS.org, a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states.
Walker, Liz; Gilson, Lucy
This study investigates how a group of nurses based in busy urban primary care health clinics experienced the implementation of the free care (the removal of fees) and other South African national health policies introduced after 1996. The study aimed to capture the perceptions and perspectives of front-line providers (street-level bureaucrats) concerning the process of policy implementation. Using qualitative and quantitative research methods, the study paid particular attention to the personal and professional consequences of the free care policy; the factors which influence nurses' responses to policy changes such as free care; and what they perceive to be barriers to effective policy implementation. The research reveals firstly that nurses' views and values inform their implementation of health policy; secondly that nurses feel excluded from the process of policy change; and finally that social, financial and human resources are insufficiently incorporated into the policy implementation process. The study recommends that the practice of policy change be viewed through the lens of the 'street-level bureaucrat' and highlights three sets of related managerial actions.
Lustbader, D; Fein, A
It is likely that greater on-site intensivist coverage in critical care units will be observed in the future. Regionalization of critical care services will make this a financial reality because this level of expertise cannot realistically be provided to all hospitals. Perhaps units above a certain size will warrant this level of coverage and smaller community hospitals will transfer patients in need of a very high level of service, which can be provided only by intensivists on site. Community hospitals may rely on specially trained nurse practitioners or physician assistants to provide more on-site coverage during off hours. As technology advances, telemedicine will play a greater role in providing intensivist coverage to ICUs during off hours or to community hospitals in remote areas. Advanced technology and reorganization of critical care services offer opportunities for creative and nontraditional ways to deliver improved care to patients.
Full Text Available Joanne Porter, Julia Morphet, Karen Missen, Anita Raymond School of Nursing and Midwifery, Monash University, Churchill, VIC, Australia Aim: To measure final-year nursing students’ preparation for high-acuity placement with emphasis on clinical skill performance confidence. Background: Self-confidence has been reported as being a key component for effective clinical performance, and confident students are more likely to be more effective nurses. Clinical skill performance is reported to be the most influential source of self-confidence. Student preparation and skill acquisition are therefore important aspects in ensuring students have successful clinical placements, especially in areas of high acuity. Curriculum development should aim to assist students with their theoretical and clinical preparedness for the clinical environment. Method: A modified pretest/posttest survey design was used to measure the confidence of third-year undergraduate nursing students (n = 318 for placement into a high-acuity clinical setting. The survey comprised four questions related to clinical placement and prospect of participating in a cardiac arrest scenario, and confidence rating levels of skills related to practice in a high-acuity setting. Content and face validity were established by an expert panel (α = 0.90 and reliability was established by the pilot study in 2009. Comparisons were made between confidence levels at the beginning and end of semester. Results: Student confidence to perform individual clinical skills increased over the semester; however their feelings of preparedness for high-acuity clinical placement decreased over the same time period. Reported confidence levels improved with further exposure to clinical placement. Conclusion: There may be many external factors that influence students’ perceptions of confidence and preparedness for practice. Further research is recommended to identify causes of poor self-confidence in final-year nursing
Duhamel, Karen V
The purpose of this paper is to explore empirical findings of five studies related to graduate-level nurse educators' and nursing students' perceptions about the roles of creativity and creative problem-solving in traditional and innovative pedagogies, and examines conceptual differences in the value of creativity from teacher and student viewpoints. Five peer-reviewed scholarly articles; professional nursing organizations; conceptual frameworks of noted scholars specializing in creativity and creative problem-solving; business-related sources; primary and secondary sources of esteemed nurse scholars. Quantitative and qualitative studies were examined that used a variety of methodologies, including surveys, focus groups, 1:1 interviews, and convenience sampling of both nursing and non-nursing college students and faculty. Innovative teaching strategies supported student creativity and creative problem-solving development. Teacher personality traits and teaching styles receptive to students' needs led to greater student success in creative development. Adequate time allocation and perceived usefulness of creativity and creative problem-solving by graduate-level nurse educators must be reflected in classroom activities and course design. Findings indicated conservative teaching norms, evident in graduate nursing education today, should be revised to promote creativity and creative problem-solving development in graduate-level nursing students for best practice outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.
Lee, Laurie A; Jones, Luann R
Neonatal nurse practitioners (NNPs) have been in practice for over 3 decades. More recently, NNPs have begun to take ownership for building their group practice models. The purpose of this article is to present a detailed case study demonstrating how one NNP group used a 4-phase strategic planning process to turn a crisis into an opportunity. The article describes data obtained during the strategic planning process from an informal national survey of NNP managers that focused on key benchmarks, such as role definition, responsibilities, protected nonclinical time, NNP salary and benefits, and educational and professional development support. Using the strategic planning process, the group defined mutually agreed upon minimum safe staffing levels for NNPs, interns, residents and neonatologists in their setting. Based on the data generated, the group successfully justified additional NNP positions and organizational support for 10% protected nonclinical time. A sample operational budget, comparison of 3 staffing scenarios, and a timeline are also provided.
Zohar Feldman; Avishai Mandelbaum; William A. Massey; Ward Whitt
This paper develops methods to determine appropriate staffing levels in call centers and other many-server queueing systems with time-varying arrival rates. The goal is to achieve targeted time-stable performance, even in the presence of significant time variation in the arrival rates. The main contribution is a flexible simulation-based iterative-staffing algorithm (ISA) for the M t /G/s t + G model--with nonhomogeneous Poisson arrival process (the M t ) and customer abandonment (the + G). F...
Kutney-Lee, Ann; Lake, Eileen T.; Aiken, Linda H.
Better patient outcomes are often achieved through effective surveillance, a primary function of nurses. The purpose of this paper is to define, operationalize, measure, and evaluate the nurse surveillance capacity of hospitals. Nurse surveillance capacity is defined as the organizational features that enhance or weaken nurse surveillance. It includes a set of registered nurse (staffing, education, expertise, experience) and nurse practice environment characteristics. Empirical referents were...
Humphries, Anne; Woods, Martin
Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice - hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of its kind carried out in New Zealand. The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate. This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research. Ethics approval for this study was granted by the New Zealand Ministry of Health's Central Regional Health and Disability Ethics Committee on 14 June 2012. The themes identified in the data centred on three dominant elements that - together - shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff. While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses' ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere. Moral distress is inevitable in an ethical climate where the organisation's main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care. © The Author(s) 2015.
Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F
Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.
Unal, Sati; Hisar, Filiz; Görgülü, Ulkü
The aim of the study was to investigate students' verbal violence experiences, the effect of assertiveness on being subjected to violence, the behaviour of students after the violence and the experience of psychological distress during practical training. The study sample consisted of 274 students attending a school of nursing. A questionnaire form and the Rathus Assertiveness Schedule (RAS) were used for data collection. Percentages, means and the independent samples t-test were used for the evaluation of data. During practical training, the students suffered verbal violence from teachers, department nurses and doctors. The students had higher mean scores of RAS for most types of violence committed by the teachers and being reprimanded by the nurses and 69.3% had not responded to the violence. Students with a high level of assertiveness are subjected to violence more frequently. Being subjected to verbal violence and feeling psychological distress during practical training are a major problem among nursing students. Students should be supported in terms of assertiveness and dealing with violence effectively.
White, Pamela; Rowland, Amy Beth; Pesis-Katz, Irena
The peer-led team learning (PLTL) model was introduced into a graduate-level course in health economics at our school of nursing. We believed this collaborative learning program, emphasizing peer-to-peer interaction to solve complex problems, would increase student engagement and mastery of course content. The course was redesigned to accommodate a weekly 1-hour workshop conducted by peer leaders. To gain better understanding of the effect of the PLTL model, focus groups were conducted at the end of the course. Evaluation of the focus group discussions showed that peer-led workshops helped students understand the subject matter. The opportunity to discuss concepts taught during lecture with their peers helped deepen students' understanding of the material and apply this knowledge in the classroom. These findings support continuation of the PLTL model in future health economics classes and suggest that this approach may be beneficial in other graduate level-nursing courses.
Full Text Available The Anatomy is the most basic lecture of the departments that give health education. The human anatomy is need to be comprehended to success in nursing field. Anatomy subjects are taught independently in each committee in Nursing Department that is in School of Health in Kocaeli University. The aim of our study is assessment of the impact of the Anatomy lectures on Anatomy Self-Efficacy Beliefs of nursing students. Totally 95 students (mean of ages 19,13 ± 1,595 who are 25 boys (%26,3 and 70 girls (%73,7 attended to our research. Anatomy Self-Efficacy Belief (ASEB scale and personal information survey(age, gender, the geographical region that he/she came from, the place that he/she resides are applied to these students. Statistically, when the relation between ASEB levels of the students and their residences was assessed, it is found that there is a significant difference on between the ASEB levels of the students who reside in dormitory and that of the students who reside at home (p<0.05. This outcome makes think that the residences of students can be effective on their success levels on the lectures. Due to the fact that dormitories that are in campus are close to the university, the attendances of lectures of students who reside in dormitory are more than the others and it shows that these students are able to study better than the others.
While many countries are still struggling to escape the effects of the financial crisis, Brazil has experienced strong economic growth, providing a stimulus for further investment and temporary staffing agency expansion. This Working Brief aims to outline some of the developments that have occurred in the temporary staffing industry in Brazil. I briefly outline the regulatory context for temporary staffing in Brazil before highlighting the characteristics of the industry and detailing the eme...
Hickey, Patricia A; Gauvreau, Kimberlee; Jenkins, Kathy; Fawcett, Jacqueline; Hayman, Laura
The objective of the study was to examine the impact of staffing ratios on risk-adjusted outcomes for pediatric cardiac surgery programs in California and relative to other states combined. California performs 20% of the nation's pediatric cardiac surgery and is the only state with a nurse ratio law. Understanding the imposition of mandated ratios on pediatric outcomes is necessary to inform the debate about nurse staffing. Patient variables were extracted from the Healthcare Cost and Utilization Project Kids' Inpatient Database. The American Hospital Association database was used for institutional variables. Descriptive analyses were used to identify and describe patient, nursing, and hospital characteristics. Changes in nursing ratios and full-time equivalents (FTEs) between 2003 and 2006 were examined. Associations between nursing characteristics and each outcome variable were examined using general estimating equation models. The RACHS-1 (Risk Adjustment for Congenital Heart Surgery) risk adjustment method was used for mortality. Hospitals in California significantly increased RN FTEs (P = .025) and RN ratios (P = .036) after enactment of AB 394 in 2006. Neither RN FTEs nor RN ratios were associated with mortality, complications, or resource utilization after risk adjustment. After the law, California's standardized mortality ratio (SMR) decreased more (33%) than in all other states combined (29%). Standardized complication ratio (SCR) increased by 5% but decreased by 5% for all other states combined, and the increase in charge differential ($53,443) was more than twice the increase ($23,119) for other states combined. Hospitals in California made upward adjustments in nursing FTEs and ratios after enactment of AB 394. There was a substantial increase in California's charge differential, a decrease in SMR, and an increase in SCR after enactment of the legislation.
Miltner, Rebecca S; Jukkala, Angela; Dawson, Martha A; Patrician, Patricia A
Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role. Copyright 2015, SLACK Incorporated.
Bower, F L; Timmons, M E
Because of the need for advanced practice nurses to perform more outcome measurement, a survey was conducted in the fall of 1997 to determine how master's level students learned the research process. Three hundred four surveys were mailed to schools with master's programs, and 222 were returned for a return rate of 73%. Sixty-six percent of the programs surveyed required a thesis and/or a research project. However, there was great variation in the research projects. A comprehensive examination was used to measure research ability by 36 programs (16%), either in conjunction with a thesis or research project or alone. One hundred forty-six programs (66%) offered only one option, be it a thesis, research project, comprehensive examination, or the many other alternative activities described by respondents. Seventy-six programs (34%) offered a variety of options from which students could select. The major differences between the thesis and the research project were related to three issues: a) the nature of the supervision; b) whether the activity was an individual or group project; and c) the amount of participation of the students. Because of the variability of expectations and the ways students are taught research, it was recommended nurse educators determine whether master's level nurse graduates were prepared to conduct outcome measurement and whether the means used to teach the research process were effective considering that endeavor.
Truemper, Christina M
Graduate-level nursing students need to be able to express concepts both verbally and in writing. For many students this will be an accumulative ongoing process that is guided by the instructors in each successive class. It is important that instructors use a tool that can consistently assess and evaluate student work, while providing feedback. Scoring rubrics do this by directing students toward areas that need improvement, while also giving credit for those items that are done correctly. Scoring rubrics can be used for both written and oral assignments and can be individualized to fit the context of the subject matter. Although rubrics have been largely associated with undergraduate students, they can improve the ability of graduate nursing students in the areas of written and verbal communication.
Describes the nursing program at Salish Kootenai College, focusing on recruitment, retention, individual curriculum plans, remedial/refresher courses in math and science, staffing, clinical practica, student responses, and funding. (DMM)
Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Maruotti, Antonello; Ball, Jane; Briggs, Jim; Meredith, Paul; Redfern, Oliver C; Kovacs, Caroline; Prytherch, David; Smith, Gary B; Griffiths, Peter
Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes. A considerable body of evidence support the hypothesis that lower levels of registered nurses on duty increases the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear. Systematic review. We searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses' aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review. Fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary-tract infections (UTIs), patient falls, pressure ulcers, critical incidents, quality of care, and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged. The review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self-reported data. In order to support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care. More research that uses objective staffing and outcome measures is required
Clarke, David J
To identify and synthesise the available research evidence in order to generate an explanatory framework for nursing practice in stroke rehabilitation. Although nurses are the largest professional group working with stroke survivors, there is limited understanding of nursing practice in stroke units. In particular, there is currently very little evidence in respect of nurses' involvement in poststroke rehabilitation. Meta-ethnography. A systematic review was undertaken. The review question was: 'What is the nature of nursing practice in the care and rehabilitation of inpatient stroke survivors?' Searches of 12 electronic databases identified 14,655 publications, and after screening, 778 remained; 137 papers were obtained and 54 retained for mapping. Sixteen qualitative studies were included in the meta-ethnography. Nurses' involvement in poststroke rehabilitation was limited. Contextual factors impacted on nurses' perceptions and practice. Nurses' integration of rehabilitation skills was perceived to be contingent on adequate nurse staffing levels and management of demands on nurses' time. Team working practices and use of the built environment indicated separation of nursing and therapy work. Physical care and monitoring were prioritised. Stroke-specific education and training was evident, but not consistent in content or approach. Stroke survivors and families needed help to understand nurses' role in rehabilitation. The review provides compelling evidence that there is an need to re-examine the role of nurses in contributing to poststroke rehabilitation, including clarifying when this process can safely begin and specifying the techniques that can be integrated in nurses' practice. Integrating stroke-specific rehabilitation skills in nurses' practice could contribute substantially to improving outcomes for stroke survivors. The explanatory framework developed from the review findings identifies issues which will need to be addressed in order to maximise nurses
Castle, Nicholas G
Consistent assignment refers to the same caregivers consistently caring for the same residents almost every time caregivers are on duty. This article examines the association of consistent assignment of nurse aides with turnover and absenteeism. Data came from a survey of nursing home administrators, the Online Survey Certification and Reporting data, and the Area Resource File. The measures were from 2007 and came from 3,941 nursing homes. Multivariate logistic regression models were used to examine turnover and absenteeism. An average of 68% of nursing homes reported using consistent assignment, with 28% of nursing homes using nurse aides consistent assignment at the often recommended level of 85% (or more). Nursing homes using recommended levels of consistent assignment had significantly lower rates of turnover and of absenteeism. In the multivariate analyses, consistent assignment was significantly associated with both lower turnover and lower absenteeism (p assignment is a practice recommended by many policy makers, government agencies, and industry advocates. The findings presented here provide some evidence that the use of this staffing practice can be beneficial.
Sisinyana H. Khunou
Full Text Available Background: Job satisfaction and burnout have been recurring problems amongst nurses in the Republic of South Africa (RSA. As a result, nurses are still leaving the rural public sector in search of lucrative work at the urban and private sectors and in developed countries. Accordingly, Occupational Specific Dispensation (OSD was introduced as a strategy to ircumvent the problem. However, since the implementation of OSD in 2007, there have been no studies conducted regarding the level of job satisfaction amongst nurses after the implementation of OSD in the North-West Province, especially because each province has its own challenges that are unique to the area.Objectives: The study had two objectives: to describe the level of job satisfaction amongstprofessional and other category nurses (OCNs at a public hospital in the North-West Provinceand describe the perceptions of nurses about OSD and their intention to continue working inthe hospital.Method: A quantitative descriptive cross-sectional design was used. Stratified random sampling was used to select a sample of 92 professional nurses (PNs, 90 enrolled nurses and enrolled nursing assistants (Nursing Act 2005, which made a total of 182 participants. For the purpose of the study, the enrolled nurses and enrolled nursing assistants were referred to as OCNs. Data were collected using the Minnesota Satisfaction Questionnaire–short form and OSD statements and analysed with Statistical Package for Social Science (SPSS, version 18.Results: The majority of PNs (79.3%, n = 73 and OCNs (86.7%, n = 77 were dissatisfied with the working conditions and salary: PNs (80.4%, n = 74 and OCNs (87.8%, n = 79. The nurses mostly discredited the current state of the OSD implementation. Majority of the PNs (84%, n = 77 and OCNs (91%, n = 82 disagreed with the statement that ‘level of job satisfaction has improved after the implementation of OSD’.Conclusions: The National Department of Health should consider a
Full Text Available Objective:To analyze the problems existed in nursing students at different levels in the process of intravenous infusion, to make judgmental guide towards common problems in clinical teaching, to standardize nursing students’ operations at intravenous infusion, and to avoid errors and disputes. Methods: The authors analyzed the problems in secondary, tertiary, undergraduate nursing students in three levels at a provincial hospital from 2010 to 2012 during intravenous infusion therapy; and the clinical teaching administration means were also discussed. Results: the difference of the problems existed in nursing students at different levels is not significant. P values were greater than 0.05. The top five projects that lost scores are consistent. Conclusion: The key problems that can easily cause errors and disputes are those that mostly occurred in nursing students at intravenous infusion operations. In clinical teaching, judgmental guide on common problems should be emphasized, nursing students’ operations at intravenous infusion should be standardized, the critical awareness towards clinical operations should be developed, errors and disputes should be avoided, and nursing students’ sense of professionalism should be enhanced.
Foronda, Cynthia; Lippincott, Christine; Gattamorta, Karina
Master's-level, nurse education certificate students performed virtual clinical simulations as a portion of their clinical practicum. Virtual clinical simulation is an innovative pedagogy using avatars in Web-based platforms to provide simulated clinical experiences. The purpose of this mixed-methods study was to evaluate nurse educator students' experience with virtual simulation and the effect of virtual simulation on confidence in teaching ability. Aggregated quantitative results yielded no significant change in confidence in teaching ability. Individually, some students indicated change of either increased or decreased confidence, whereas others exhibited no change in confidence after engaging in virtual simulation. Qualitative findings revealed a process of precursors of anxiety and frustration with technical difficulties followed by outcomes of appreciation and learning. Instructor support was a mediating factor to decrease anxiety and technical difficulties. This study served as a starting point regarding the application of a virtual world to teach the art of instruction. As the movement toward online education continues, educators should further explore use of virtual simulation to prepare nurse educators.
Meneghin, P; Stefanelli, M C; Cianciarullo, T I
The importance of communication in organizational nursing culture and the nursing manager skills to improve the process of communicating are emphasized in this work. Communication ways in the nursing setting and the nurses' view about effectiveness of these ways are related.
Carrillo-García, C; Ríos-Rísquez, M I; Martínez-Hurtado, R; Noguera-Villaescusa, P
The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N=89). The mean of the Social support dimension was 3.13±0.397, for the Psychological demands at work dimension it was 3.10±0.384, with a mean of 2.96±0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample.
... 42 Public Health 2 2010-10-01 2010-10-01 false Condition of participation: Staffing. 403.740 Section 403.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...-Benefits, Conditions of Participation, and Payment § 403.740 Condition of participation: Staffing....
Maenhout, Broos; Vanhoucke, Mario
When scheduling projects assumptions are made with respect to the personnel resource availability. In personnel scheduling problems assumptions are made with respect to the staffing requirements. We explore how to integrate these two scheduling problems for making strategic project staffing decisions. More precisely, we determine the number of personnel and required skill mix to complete a project.
Zimmerman, Sheryl; Gruber-Baldini, Ann L; Hebel, J Richard; Sloane, Philip D; Magaziner, Jay
Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up. A stratified random sample of 59 nursing homes across Maryland. Two thousand fifteen new admissions aged 65 and older. Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records). The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes. The association between RN
Li, Yue; Spector, William D; Glance, Laurent G; Mukamel, Dana B
To improve nursing home quality, many states have developed "technical assistance programs" that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.
Identificação das intervenções de enfermagem na Atenção Primária à Saúde: parâmetro para o dimensionamento de trabalhadores Identificación de las intervenciones de enfermería en la atención primaria de salud: parámetro para el dimensionamiento de trabajadores The identification of nursing interventions in primary health care: a parameter for personnel staffing
APS mediante un lenguaje estandarizado, ayudando su aplicación en la construcción de instrumentos para identificación de la carga de trabajo.In Primary Health Care (PHC there is empirical planning regarding the nursing staff, which causes a distortion between personnel distribution and the real needs of the health units. The objective was to identify the nursing interventions at the PHC that support personnel staffing. The following sources were: literature review of databases from 1999-2009; field observation at a Family Health Unit; survey of family forms; mapping of nursing activities and interventions according to the Nursing Interventions Classification; and validation of these interventions. A total of 169 activities were identified: 11 associated activities; five personnel activities and 153 direct and indirect care giving activities validated in seven domains, 15 classes and 46 NIC interventions. The study allowed for recognition of the nursing practices at the PHC by means of a standardized language, providing support for its application in the creation of instruments to identify the nursing workload.
Full Text Available In this study, it is aimed to identify the burnout levels of nurses which prevent them from doing their business more efficiently and to examine the effects of various demographic variables on burnout. The data necessary for the research have been gathered from 256 nurses working in public hospitals within borders of central district of Denizli province using “Maslach Burnout Inventory”. They were analyzed by SPSS and CHAID was used as the analysis method. In consequence it has been determined that nurses experience low-level emotional exhaustion, average-level depersonalization and high-level decrease in personal accomplishment. It has also been concluded that burnout levels are affected by demographic properties such as age, marital status, tenure of office, daily workload, education and income level
Lin, Tzu-Ching; Lin, Huey-Shyan; Cheng, Su-Fen; Wu, Li-Min; Ou-Yang, Mei-Chen
This study aimed to examine the relationship between work stress and depression; and investigate the mediating effect of occupational burnout among nurses in paediatric intensive care units. The relationships among work stress, occupational burnout and depression level have been explored, neither regarding occupational burnout as the mediating role that causes work stress to induce depression nor considering the paediatric intensive care unit context. A cross-sectional correlational design was conducted. One hundred and forty-four female paediatric intensive care unit nurses from seven teaching hospitals in southern Taiwan were recruited as the participants. Data were collected by structured questionnaires including individual demographics, the Nurse Stress Checklist, the Occupational Burnout Inventory and the Taiwan Depression Questionnaire. The results indicated that after controlling for individual demographic variables, the correlations of work stress with occupational burnout, as well as work stress and occupational burnout with depression level were all positive. Furthermore, occupational burnout may exert a partial mediating effect on the relationship between work stress and depression level. This study provides information about work stress, occupational burnout and depression level, and their correlations, as well as the mediating role of occupational burnout among paediatric intensive care unit nurses. It suggests government departments and hospital administrators when formulating interventions to prevent work stress and occupational burnout. These interventions can subsequently prevent episodes of depression in paediatric intensive care unit nurses, thereby providing patients with a safe and high-quality nursing environment. © 2016 John Wiley & Sons Ltd.
Full Text Available No abstract available. Article truncated at 150 words. Substituting nursing assistants for professional nurses is associated with poorer quality of care and increased mortality according to a study published in BMJ Quality & Safety (1. Linda H. Aiken PhD and colleagues analyzed the effect of increasing the proportion of less extensively trained nurses at 243 acute care hospitals in Belgium, England, Finland, Ireland, Spain, and Switzerland. They surveyed 13,077 nurses and 18,828 patients who had been in 182 hospitals between 2009 and 2010. They also consulted mortality records for 275,519 patients who had had surgery in 188 of the hospitals between 2007 and 2009. Overall, 47% of the professional nurses in the study had bachelor's degrees, although they were unevenly distributed, with some hospitals having none. In a hospital that has average nurse staffing levels and skill mix, the researchers estimated that replacing one professional nurse with a lower-skilled worker increased the odds of a patient dying by …
刘晓慧; 王申; 张瑾; 王凝
目的：了解天津市护士同情心疲乏水平及其相关影响因素，探讨降低护士同情心疲乏的有效途径。方法采用一般情况调查表、医护人员同情心疲乏量表、护理工作环境量表和一般自我效能量表，对天津市4所三级甲等医院的477名护士进行调查。结果护士的同情心疲乏均分为（2.70±0.34）分，处于中度水平；护理工作环境与自我效能均分分别为（2.99±0.49）、（2.42±0.63）分，处于中等偏上水平；单因素方差分析发现，年龄、护龄、所在科室、婚姻对护士同情心疲乏的影响有统计学意义（P<0.05）。多元回归分析结果显示，护龄、高质量护理服务基础、充足的人力物力、护理管理者能力和领导力以及自我效能可预测护士同情心疲乏的发生。结论临床护士存在不同程度的同情心疲乏，其中工作环境及自我效能对同情心疲乏有显著影响，因此可通过改善护理工作环境、提高自我效能方面来预防和缓解同情心疲乏。%Objective To investigate the current status and influencing factors of compassion fatigue in nurses. Methods A total of 477 nurses from 4 hospital in Tianjin were investigated with the self-designed demographic questionnaire, Compassion Fatigue Scale, Practice Environment Scale and General Self-Efficacy Scale. Results The mean score of compassion fatigue, practice environment and general self-efficacy were showed respectively as following: (2.70 ± 0.34), (2.99 ± 0.49) and (2.42 ± 0.63) points, which indicated at a moderate level. Single factor analysis found that marriage, age, nursing age, department had statistically significant influence on compassion score of nurses(P<0.05). Multiple regression analysis showed that nursing age, nursing foundations for quality of care, staffing and resource adequacy, nurse manager ability, leadership and self-efficacy were indicated as predictive factors of compassion fatigue
Gallucci, Andrew R; Petersen, Jeffrey C
Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified. To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition. Cross-sectional study. Web-based survey. Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs. Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students. The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft(2) (290.3 ± 411 m(2)) for the central athletic training facility, 1013 ± 1521 ft(2) (94 ± 141 m(2)) for satellite athletic training facilities, 1272 ± 1334 ft(2) (118 ± 124 m(2)) for game-day athletic training facilities, 388 ± 575 ft(2) (36 ± 53 m(2)) for athletic training offices, and 424 ± 884 ft(2) (39 ± 82 m(2)) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for the near future. This study provides benchmark descriptive data on athletic training staffing and
Full Text Available This research was carried out as a descriptive study in order to determine the anxiety levels of third and last year students of Ege University School of Nursing while preparing their thesis and the factors affecting this. The research was performed with 142 students from third and last year students studying at Ege University School of Nursing. Data was collected using a questionnaire prepared by the researchers and State-Trait Anxiety Inventory. It was determined that, 52,1% of the students were above the age of 23 years, 53,5% were last year students, 44,4% stayed in dormitory, 61,3% indicated that they experienced anxiety problems while determining the subject of thesis, and 38,7% got sufficient assistance from their supervisor. State anxiety average was 49,11± 12,23 and Trait anxiety average was 45,14± 7,8. Age groups, year of their study, staying with parents or receiving help from the supervisor were determined not to be effective in anxiety levels. Guiding and supporting attitudes of the teaching staff were thought to be helpful in increasing self-confidence of young people by reducing anxiety.
Edna Johana Mondragón-Sánchez
Full Text Available OBJECTIVE: to compare the level of fear of death in nursing students and professionals. METHOD: this was a comparative-transversal study examining 643 nursing students and professionals from a third-level institution. A random sampling method was employed, and the sample size was calculated by power analysis. The study was developed during three stages: the first stage consisted of the application of a pilot test, the second stage involved the recruitment of the participants, and the third stage measured the participants' responses on the Collett-Lester Fear of Death Scale. RESULTS: the average fear of death was moderate-high (-X=3.19±0.55, and the highest score was observed for the fear of the death of others (-X=3.52±0.20. Significant differences in the perceptions of fear of death were observed among the students of the first three years (p.05. CONCLUSIONS: it is possible that first-year students exhibit a reduced fear of death because they have not had the experience of hospital practice. Students in their second and third year may have a greater fear of death because they have cared for terminal patients. However, it appears that greater confidence is acquired over time, and thus fourth-year students and professionals exhibit less fear of death than second- and third-year students (p<.05.
Aaronson, W E; Zinn, J S; Rosko, M D
This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.
Araujo, Susan; Sofield, Laura
Workplace violence is not a new phenomenon and is often sensationalized by the media when an incident occurs. Verbal abuse is a form of workplace violence that leaves no scars. However, for nurses, the emotional damage to the individual can affect productivity, increase medication errors, incur absenteeism, and decrease morale and overall satisfaction within the nursing profession. This results in staffing turnover and creates a hostile work environment that affects the culture within the organization.
Ikegami, Naoki; Ikezaki, Sumie
To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the United States. National sample of 653 nursing homes with responses from 371 (57%) on their facility characteristics, 241 (37%) on their resident characteristics, and 92 (14%) on the residents' quality of life. All 5 hospitals in a city 80 miles from Tokyo cooperated. Nursing home staff answered questionnaires on facility and resident characteristics. Resident level data were obtained from 1158. The questionnaire on the quality of care was responded to by 256 (63%) of the decedents' families in nursing homes and 205 (48%) in hospitals. Facility characteristics included items on physicians, nurse staffing, and the facility's end-of-life care policy. Resident characteristics included basic demographics, level of dementia, and resident's and family's preference for the site of death. The Toolkit was used to measure the quality of end-of-life care. The proportion of those dying within the nursing home was related to the facility's policy on end-of-life care and the family's preference. The quality of end-of-life care in nursing homes was generally better than in hospitals, and than in their respective counterparts in the United States. Financial incentives by the Japanese government to promote end-of-life care in nursing homes may have contributed to increasing the proportion of deaths within the facility. The quality of care in nursing homes was evaluated as being better than hospitals. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
van Eeden, Karin; Moeke, Dennis; Bekker, René
Nursing homes face ever-tightening healthcare budgets and are searching for ways to increase the efficiency of their healthcare processes without losing sight of the needs of their residents. Optimizing the allocation of care workers plays a key role in this search as care workers are responsible for the daily care of the residents and account for a significant proportion of the total labor expenses. In practice, the lack of reliable data makes it difficult for nursing home managers to make informed staffing decisions. The focus of this study lies on the 'care on demand' process in a Belgian nursing home. Based on the analysis of real-life 'call button' data, a queueing model is presented which can be used by nursing home managers to determine the number of care workers required to meet a specific service level. Based on numerical experiments an 80/10 service level is proposed for this nursing home, meaning that at least 80 percent of the clients should receive care within 10 minutes after a call button request. To the best of our knowledge, this is the first attempt to develop a quantitative model for the 'care on demand' process in a nursing home.
The NHS will not be able to offer a high standard of service to patients if the quality of life for its staff is poor, David Poole, Chief Nursing Officer for North Bedfordshire Health Authority told the conference.
Lukasz Maciej Mazur
Full Text Available Medication errors occurring in hospitals are a growing national concern. These medication errors and their related costs (or wastes are seen as major factors leading to increased patient safety risks and increased waste in the hospital setting. This article presents a study in which sixteen entry-level nurses utilized a Toyota Production System (TPS analysis procedure to solve medication delivery problems at one community hospital. The objective of this research was to study and evaluate the TPS analysis procedure for problem solving with entry-level nurses. Personal journals, focus group discussions, and a survey study were used to collect data about entry-level nurses’ perceptions of using the TPS problem solving approach to study medication delivery. A regression analysis was used to identify characteristics that enhance problem solving efforts. In addition, propositions for effective problem solving by entry-level nurses to aid in the reduction of medication errors in healthcare delivery settings are offered.
Tasdemir, Rabia; Sivri, İsmail; Güzelordu, Dilsat; Yener, Mehmet Deniz; Aksu, Elif; Colak, Serap; Bamac, Belgin; Colak, Tuncay
.... The human anatomy is need to be comprehended to success in nursing field. Anatomy subjects are taught independently in each committee in Nursing Department that is in School of Health in Kocaeli University...
Liang, Bohui; Turkcan, Ayten
The oncology clinics use different nursing care delivery models to provide chemotherapy treatment to cancer patients. Functional and primary care delivery models are the most commonly used methods in the clinics. In functional care delivery model, patients are scheduled for a chemotherapy appointment without considering availabilities of individual nurses, and nurses are assigned to patients according to patient acuities, nursing skill, and patient mix on a given day after the appointment schedule is determined. Patients might be treated by different nurses on different days of their treatment. In primary care delivery model, each patient is assigned to a primary nurse, and the patients are scheduled to be seen by the same nurse every time they come to the clinic for treatment. However, these clinics might experience high variability in daily nurse workload due to treatment protocols that should be followed strictly. In that case, part-time nurses can be utilized to share the excess workload of the primary nurses. The aim of this study is to develop optimization methods to reduce the time spent for nurse assignment and patient scheduling in oncology clinics that use different nursing care delivery models. For the functional delivery model, a multiobjective optimization model with the objectives of minimizing patient waiting times and nurse overtime is proposed to solve the nurse assignment problem. For the primary care delivery model, another multiobjective optimization model with the objectives of minimizing total overtime and total excess workload is proposed to solve the patient scheduling problem. Spreadsheet-based optimization tools are developed for easy implementation. Computational results show that the proposed models provide multiple nondominated solutions, which can be used to determine the optimal staffing levels.
Karadag Arli, Senay; Bakan, Ayse Berivan; Erisik, Ela
This study aims to evaluate the relationship between nurses' views on spirituality and spiritual care and their level of burnout. This cross-sectional study used a convenience sample that comprised 118 nurses from one state hospital in eastern Turkey. The data were collected through questionnaires that were filled by the nurses individually, using a sociodemographic characteristics form, the Spirituality and Spiritual Care Rating Scale, and the Maslach Burnout Inventory. A statistically significant relationship was found between subscale scores of Maslach Burnout Inventory and total score of Spirituality and Spiritual Care Rating Scale. With the increase in nurses' spiritual care mean scores, there was an increase in the mean scores of the Emotional Exhaustion, Depersonalization, and Personal Accomplishment subscales. Nurses' burnout levels increased with the increase in their spirituality and spiritual care mean scores. This situation can be associated with the fact that providing spiritual care increases nurses' workload. Therefore, similar studies are recommended to be conducted with wider groups of participants. © The Author(s) 2016.
Decker, Frederic H
Poorer resident care in US for-profit relative to not-for-profit nursing homes is usually blamed on the profit motive. But US nursing home performance may relate to Medicaid public financing in a manner qualifying the relationship between ownership and quality. We investigated effects of Medicaid resident census, Medicaid payment, and occupancy on performance. Resource dependence theory implies these predictors may affect discretion in resources invested in resident care across for-profit and not-for-profit facilities. Models on physical restraint use and registered nurse (RN) staffing were studied using generalized estimating equations with panel data derived from certification inspections of nursing homes. Restraint use increased and RN staffing levels decreased among for-profit and not-for-profit facilities when the Medicaid census increased and Medicaid payment decreased. Interaction effects supported a theory that performance relates to available discretion in resource allocation. Effects of occupancy appear contingent on the dependence on Medicaid. Poorer performance among US for-profit nursing homes may relate to for-profit homes having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes. Understanding the complexity of factors affecting resources expended on resident care may further our understanding of the production of quality in nursing homes, whether in the US or elsewhere.
Sabatino, Laura; Kangasniemi, Mari Katariina; Rocco, Gennaro; Alvaro, Rosaria; Stievano, Alessandro
The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. The purpose of this study was to determine how nurses described nursing's professional dignity in internal medicine and surgery departments in hospital settings. The research design was qualitative. This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. A total of 124 nurses participated in this study. The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Nursing's professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing's professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different
May 5, 2008 ... ... up to three quarters of recurrent budgets, a need arises to ascertain ... Main outcome measures: The cadres of workers, working schedules, main activities, time taken ..... Christ, W.R. A method for setting social work staffing.
Topaz, Maxim; Ronquillo, Charlene; Peltonen, Laura-Maria; Pruinelli, Lisiane; Sarmiento, Raymond Francis; Badger, Martha K; Ali, Samira; Lewis, Adrienne; Georgsson, Mattias; Jeon, Eunjoo; Tayaben, Jude L; Kuo, Chiu-Hsiang; Islam, Tasneem; Sommer, Janine; Jung, Hyunggu; Eler, Gabrielle Jacklin; Alhuwail, Dari; Lee, Ying-Li
This study presents a qualitative content analysis of nurses' satisfaction and issues with current electronic health record (EHR) systems, as reflected in one of the largest international surveys of nursing informatics. Study participants from 45 countries (n=469) ranked their satisfaction with the current state of nursing functionality in EHRs as relatively low. Two-thirds of the participants (n=283) provided disconcerting comments when explaining their low satisfaction rankings. More than one half of the comments identified issues at the system level (e.g., poor system usability; non-integrated systems and poor interoperability; lack of standards; and limited functionality/missing components), followed by user-task issues (e.g., failure of systems to meet nursing clinical needs; non nursing-specific systems) and environment issues (e.g., low prevalence of EHRs; lack of user training). The study results call for the attention of international stakeholders (educators, managers, policy makers) to improve the current issues with EHRs from a nursing perspective.
Heslop, Liza; Plummer, Virginia
Coding, costing, and accounting for nursing care requirements in Australian public and private hospitals lacks systematic research. Nurse costing for two nurse staffing allocation methods--nurse patient ratios and a computerized nurse dependency management system--were compared. Retrospective nursing workload management data were obtained from hospital information systems in 21 acute care public and private hospitals in Australia and New Zealand. Descriptive statistics, cost analysis, and cost modeling were conducted for 103,269 shifts of nursing care. The comparison of costs for nursing staff by nurse-patient ratios and by a computerized nurse dependency management system demonstrated differences. The provision of nursing care using the computerized nurse dependency management system was, overall, lower in cost than for nurse-patient ratios.
Bernreuter, M E
The Fair Labor Standards Act allows exemption of professionals from overtime pay. However, this is often disregarded, and professional staff are compensated as nonexempt employees. The workweek definition then assumes increased importance as it may be a determining factor in the cost and availability of staff. This article discusses how altering the workweek may improve staffing. Various schedules are exhibited, and staffing and overtime pay implications of each are discussed.
[Planning and application of a valutation methodology in UNI EN ISO 9001:2000 quality system, for the analysis satisfaction level of third-year student University of Bologna, Bachelor of Nursing Course, CRI School of Nursing formative section].
Bernardi, M G; Scalorbi, Sandra; Burrai, Francesco
The quality of nursing assistance is closely related to the quality of training. In the certification UNI EN ISO 9001:2000 in 2004 of the Bologna nursing school regarding Planning and performance of theoretical-practical nursing training a continual improvement of the product/service is implicit. A method was therefore devised to evaluate the degree of satisfaction in third-year nursing students in Bologna which demonstrated a medium/high level of satisfaction regarding all teaching-related procedures. By monitoring satisfaction levels , it is possible to identify any critical areas and to implement improvement where needed.
Gallagher, Regan; Gormley, Denise K
Bone marrow transplantation (BMT) is used to treat various conditions, ranging from immune disorders to many types of cancer. The critical complexity of patients and the environment in which BMT nurses work can lead to stress, burnout, and, ultimately, poor retention. This study aimed to investigate nurses' perceptions of work-related stress and burnout as well as current support systems for nurses. The study included 30 BMT staff nurses from a large pediatric medical center in the midwestern United States. Critical illness or acuity of patients was reported as the most stressful factor; long work hours was the least stressful factor. Most nurses perceived moderate to high levels of emotional exhaustion, and 33% reported moderate levels of depersonalization. Fifty percent perceived high levels of personal accomplishment, despite the critical illness or acuity of their patients, demanding patient families, rotating shifts, short staffing, and caring for dying patients. Most nurses felt that support systems were in place and that staff was accessible, but most respondents were undecided about the helpfulness of the support systems. Results suggest that support systems may significantly affect work satisfaction and feelings of accomplishment for BMT nurses.
Hatcher, S; Laschinger, H K
Kanter's structural theory of organizational behavior was used as framework to explore the relationship between perceptions of power and opportunity and level of burnout in a sample of 87 hospital staff nurses. Data were collected using a modified version of the Conditions for Work Effectiveness Questionnaire (Chandler, 1986) and the Human Services Survey (Maslach & Jackson, 1986). Consistent with Kanter's theory, perceived access to power and opportunity was significantly related to the three aspects of burnout: level of emotional exhaustion and depersonalization (r = -.3419, p = .004; r = -.2931, p = .02), and personal accomplishments (r = .3630, p = .002). The results of this study are useful for nurse administrators positioned to create organizational structures than empower staff nurses and subsequently decrease burnout.
Williams, G; Chaboyer, W; Alberto, L; Thorsteinsdottir, R; Schmollgruber, S; Fulbrook, P; Chan, D; Bost, N
This study is the second world survey of critical care nursing organizations (CCNOs). The first survey was undertaken 6 years ago and data were collected from 23 countries over a 2-year period. The aim of the second survey was to profile the issues and activities of critical care nurses and their professional organizations, expanding on the previous survey to obtain both an update of the issues and a wider global perspective. A descriptive survey was emailed to 80 potential responding countries with recognized CCNOs or nursing leaders. Responses were analysed descriptively by geographical region. A total of 51 respondents completed the questionnaire over a 6-month period, achieving a return rate of 64%. The most common issues identified by critical care nurses were staffing levels and teamwork. Other important issues included wages, working conditions and access to quality educational programmes. The respondents perceived national conferences, professional representation, standards for educational courses, provision of a website, and educational workshops and forums as the five most important activities that should be provided for critical care nurses by national CCNOs. Workforce and education issues remain dominant themes among critical care nurses of the world. These issues have changed very little in the last 6 years. Using the World Federation of Critical Care Nurses network of regional CCNOs and critical care nursing leaders has proven to be a successful strategy for the collection of data on world issues and for international communication and support.
Jacono, Brenda; Young, Lynne; Baker, Cynthia; Richardson, Holly R L; Cable-Williams, Beryl; Jewers, Heather; Lavoie, Mireille; Librach, Larry; Bidgood, Darcee; Mitchell, Mitzi Grace
Educational preparation of health professionals for Palliative and End of Life Care (PEOLC) is inadequate, and nurses are no exception. In 2004, the Canadian Association of Schools of Nursing struck a Task Force to develop PEOLC competencies to address this issue. The development of national PEOLC nursing competencies involved a multi-step, emergent, interactive, and iterative process. An overarching principle guiding this process was building national consensus about the essential PEOLC specific competencies for nurses among experts in this field while simultaneously generating, revising, and refining them. There have been three stages in this iterative, multi-step process: 1) Generating a preliminary set of competencies, 2) Building a national consensus among educators and experts in the field on PEOLC specific competencies for nurses, and 3) Refining the consensus based competencies for curriculum development. Ongoing follow up work for this project is focusing on the integration of these competencies into nursing curricula.
Cortez, Eric J; Panchal, Ashish R; Davis, James E; Keseg, David P
Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]). This was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (Pambulance were shorter than the PB ambulance team (PP: 10.1 minutes, IQR 6.0-15; PB: 13.0 minutes, IQR 8.1-18; P=.01). This finding also was noted at Station B (PP: 13.5 minutes, IQR 8.5-19; PB: 14.3 minutes, IQR 9.9-20; P=.01). There were no differences between PP and PB ambulance teams at Station A or Station B in time-to-EKG, time-to-IV insertion, IV success rate, and protocol violation rates. In the setting of a well-developed EMS system utilizing an all-Advanced Life Support (ALS) response, this study suggests that PB ambulance teams may function well when compared to PP ambulances. Though longer scene times were observed, differences in
Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri
Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.
Rao, Krishna D; Ryan, Mandy; Shroff, Zubin; Vujicic, Marko; Ramani, Sudha; Berman, Peter
The scarcity of rural doctors has undermined the ability of health systems in low and middle-income countries like India to provide quality services to rural populations. This study examines job preferences of doctors and nurses to inform what works in terms of rural recruitment strategies. Job acceptance of different strategies was compared to identify policy options for increasing the availability of clinical providers in rural areas. In 2010 a Discrete Choice Experiment was conducted in India. The study sample included final year medical and nursing students, and in-service doctors and nurses serving at Primary Health Centers. Eight job attributes were identified and a D-efficient fractional factorial design was used to construct pairs of job choices. Respondent acceptance of job choices was analyzed using multi-level logistic regression. Location mattered; jobs in areas offering urban amenities had a high likelihood of being accepted. Higher salary had small effect on doctor, but large effect on nurse, acceptance of rural jobs. At five times current salary levels, 13% (31%) of medical students (doctors) were willing to accept rural jobs. At half this level, 61% (52%) of nursing students (nurses) accepted a rural job. The strategy of reserving seats for specialist training in exchange for rural service had a large effect on job acceptance among doctors, nurses and nursing students. For doctors and nurses, properly staffed and equipped health facilities, and housing had small effects on job acceptance. Rural upbringing was not associated with rural job acceptance. Incentivizing doctors for rural service is expensive. A broader strategy of substantial salary increases with improved living, working environment, and education incentives is necessary. For both doctors and nurses, the usual strategies of moderate salary increases, good facility infrastructure, and housing will not be effective. Non-physician clinicians like nurse-practitioners offer an affordable
Palermo, Karen R.
A description is presented of "Nutrition for Nurses," a prerequisite course for students anticipating entrance into the junior level of a state university registered nursing program. Introductory material highlights the course focus (i.e., the basics of good nutrition; nutrition through the life cycle; nursing process in nutritional care; and…
Sahar Avazpor; Jamal Fazel Kalkhoran; Hojat Allah Amini
Background: High intensity interval training (HIIT) is a novel training method which has received most attention in recent years. The aim of this study was to examine the effect of 8 weeks of high intensity interval training (HIIT) on plasma levels of adiponectin and leptin in overweight nurses.Materials and Methods: 27 nurses (mean age 25.81±60 years, height 158.01±67 cm and weight 69.41±25 kg) were voluntarily selected and randomly assigned to three groups (each group 9 subjects): 1. HIIT (...
Jumaa, Mansour Olawale
The aim of this commentary is to raise awareness about the apparent lack of formal activities and the paucity of published papers in nursing leadership development at the board level in the United Kingdom (UK). The paper suggests a way forward. The author has been serving at a board level, within and outside of nursing, locally, nationally and internationally since 1988. His current experience as an active board member and honorary treasurer of a leading charity organization in the Southeast of England and participation on a Board Leadership Development programme in the United States of America (USA) led to the need to write this commentary. Leadership at the board level is different because the board is the governing body of an organization. The board has overall responsibility for running the organization. The overall duty is to manage less and LEAD more. The need for this type of leadership is on the increase because these are turbulent days in the healthcare industry. This growing trend witnesses increasing and greater demand from key stakeholders for nursing and healthcare services: rising exposure to liability and litigation; a demand for stronger accountability and questioning of the nature and delivery of nursing and healthcare services. Effective and successful leadership judgment is made based on both numbers [efficient resources utilization (RU)] and stories [effective client/patient satisfaction (CS)]. Nurses and others in the healthcare industry need to guide against the leadership myths that: 'everyone can be a leader'; 'leaders deliver business (service) results'; 'people who get to the top are leaders'; and 'that leaders are great coaches'. This commentary demonstrates these myths could be converted to become realities through developing and possessing most if not all the knowledge, skills and attitudes implicated in the Effective Board Leadership Capabilities Development Profile presented in this paper. Possessing board level leadership
Lemonde, Manon; Payman, Naghmeh
The Canadian Association of Nurses in Oncology (CANO) Standards of Care (2001) provides a framework that delineates oncology nursing roles and responsibilities. The purpose of this study was to explore how oncology nurses perceive their roles and responsibilities compared to the CANO Standards of Care. Six focus groups were conducted and 21 registered nurses (RNs) from a community-based hospital participated in this study. Transcripts were analyzed using qualitative inductive content analysis. Three themes were identified: (1) Oncology nurses perceive a gap between their defined roles and the reality of daily practice, as cancer care becomes more complex and as they provide advanced oncology care to more patients while there is no parallel adaptation to the health care system to support them, such as safe staffing; (2) Oncology nursing, as a specialty, requires sustained professional development and leadership roles; and (3) Oncology nurses are committed to providing continuous care as a reference point in the health care team by fostering interdisciplinary collaboration andfacilitating patient's navigation through the system. Organizational support through commitment to appropriate staffing and matching scope ofpractice to patient needs may lead to maximize the health and well-being of nurses, quality of patient care and organizational performance.
... 25 Indians 1 2010-04-01 2010-04-01 false Is a nurse required to be available in the evenings? 36... SITUATIONS Homeliving Programs Staffing § 36.85 Is a nurse required to be available in the evenings? No, a program is not required to make a nurse (LPN or RN) available in the evenings. However, this is...
Fischer, A; Muller, M
The process of transformation in the South African Military Health Services, has influenced the nursing service managers' level of motivation and the following research question is applicable: what are the perceptions of the nursing service managers within the South African Military Health Services on their level of motivation? The purpose with this study was to explore and describe the perceptions of nursing service managers on their level of motivation within these health services. A qualitative research design was utilized and four focus group interviews were conducted with 33 nursing service managers country wide. The transcribed interviews were exposed to a content analysis. The results confirm that the level of motivation amongst these nursing service managers is low. The demotivators relate mainly to the following: inadequate acknowledgement, job insecurity in relation to the future, problems with the process of integration, transformation and rationalization, problems with management, many labour related issues, poor/inadequate communication, inadequate support, increased work load, poor physical environment, negative publicity and poor self motivation. Although there were a few motivators identified, they were of less importance. These results were interpreted within Herzberg's motivation theory to identify the hygiene/maintenance factors and to assess whether the important motivators were in place. During any process of change, and/or when the level of motivation amongst employees is low, it is important to adequately manage the environment (hygiene/maintenance factors within the Herzberg theory). But it is even more important to ensure that the motivators are in place or to intensify them. It is therefore recommended that a motivation strategy, based on the Herzberg theory as well as the Hackman-Oldham job enrichment model, be developed, implemented and evaluated.
Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret
Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.
Full Text Available Aims: In order to preserve its own progress, nursing training has to be utilized new training methods, in such a case that the teaching methods used by the nursing instructors enhance significant learning via preventing superficial learning in the students. Conceptual Map Method is one of the new training strategies playing important roles in the field. The aim of this study was to investigate the effectiveness of the designed software based on the mobile phone computer conceptual map on the learning level of the nursing students. Materials & Methods: In the semi-experimental study with pretest-posttest plan, 60 students, who were studying at the 5th semester, were studied at the 1st semester of 2015-16. Experimental group (n=30 from Meibod Nursing Faculty and control group (n=30 from Yazd Shahid Sadoughi Nursing Faculty were trained during the first 4 weeks of the semester, using computer conceptual map method and computer conceptual map method in mobile phone environment. Data was collected, using a researcher-made academic progress test including “knowledge” and “significant learning”. Data was analyzed in SPSS 21 software using Independent T, Paired T, and Fisher tests. Findings: There were significant increases in the mean scores of knowledge and significant learning in both groups before and after the intervention (p0.05. Nevertheless, the process of change of the scores of significant learning level between the groups was statistically significant (p<0.05. Conclusion: Presenting the course content as conceptual map in mobile phone environment positively affects the significant learning of the nursing students.
Járomi, M; Kukla, A; Szilágyi, B; Ugron, Á; Kovácsné Bobály, V; Makai, A; Linek, P; Ács, P; Leidecker, E
Millions of nurses around the world suffer from occupational-related chronic non-specific low back pain (cnsLBP). Generally, LBP in nurses is a result of increased pressure on the spine, and can be associated with improperly conducted patient lifting techniques. The purposes of the study were:1) to examine patient lifting techniques used by nurses; and 2) to evaluate an effectiveness of the Spine Care for Nurses programme in cnsLBP reduction and the execution of proper patient lifting techniques. A randomized controlled trial was conducted among 137 nurses with cnsLBP. Participants were randomized into an experimental and control group (experimental group n=67, control group n=70). Nurses in the experimental group attended the Spine Care for Nurses programme for three months. The programme consisted of didactic education, spine-strengthening exercises, and education on safe patient handling techniques. The control group only received a brief written lifestyle guidance. The Zebris WinSpine Triple Lumbar examination was utilised to analyse nurses' patient lifting techniques (horizontal and vertical lifting). The lumbar pain intensity was measured with a 0-100 Visual Analogue Scale (VAS). The pre-intervention average cnsLBP intensity score on VAS decreased from 49.3, to the post-intervention score of 7.5. The correct execution of vertical lifting techniques in the experimental group increased from 8.91% to 97.01% (control group: 8.57% pre and post 11.42%). The horizontal patient lifting technique pre-intervention increased from 10.44% to 100% correct execution in the experimental group (control group: pre 10.00% and post 11.42%). The Spine Care for Nurses programme significantly reduced cnsLBP and increased the number of properly executed horizontal and vertical patient lifting techniques in nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
This study analyzed factors in attracting and recruiting professional nurses into Massachusetts state service. Although Massachusetts had relatively many registered nurses (RN), 45% were inactive. Resulting shortages were great, especially in state hospitals. All agencies had high turnover, with impending staffing crises in some agencies because…
Jiang, Hui; Ma, Lily; Gao, Caiping; Li, Tengteng; Huang, Lihua; Huang, Weiqin
Stability of the nursing workforce is considered a key factor for high-quality healthcare. Satisfaction and burnout are reported to be closely related to staff turnover. This study investigates satisfaction and burnout of ED nurses in Shanghai and association of these factors with intention to stay on the job. This is a cross-sectional descriptive survey study conducted between October and December 2015. Our own questionnaire and the Maslach Burnout Inventory were used to construct the survey. The convenience sampling method was used. The survey targeted ED nurses in 30 Shanghai hospitals. Data were analysed using descriptive, non-paired t-tests, analysis of variance and multivariable logistic regression to decipher possible causes for burnout and identify reasons for continued interest in staying on the job by ED nurses. Of 1137 nurses who received surveys, 976 (87%) responded. Among the respondents, 75% reported being very satisfied or satisfied with their jobs, but there was a high level of burnout, and 22.5% of the nurses expressed their intention to leave the ED within the following year (pburnout were associated with intention to leave. Salary, nurse-patient relationships, nurse staffing and work environment were areas where nurses were less satisfied, while group cohesion was associated with greater satisfaction. ED nurses in Shanghai report a high level of burnout, which is associated with an intention to leave their jobs. Interventions are needed to improve satisfaction and reduce burnout to maintain the stability of the nursing workforce. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available OBJECTIVES: To investigate associations between nurse work practice environment measured at department level and individual level work-family conflict on burnout, measured as emotional exhaustion, depersonalization and personal accomplishment among Swedish RNs. METHODS: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analysed here is based on a national sample of 8,620 RNs from 369 departments in 53 hospitals. RESULTS: Generally, RNs reported high values of personal accomplishment and lower values of emotional exhaustion and depersonalization. High work-family conflict increased the risk for emotional exhaustion, but for neither depersonalization nor personal accomplishment. On department level adequate staffing and good leadership and support for nurses reduced the risk for emotional exhaustion and depersonalization. Personal accomplishment was statistically significantly related to staff adequacy. CONCLUSIONS: The findings suggest that adequate staffing, good leadership, and support for nurses are crucial for RNs' mental health. Our findings also highlight the importance of hospital managers developing policies and practices to facilitate the successful combination of work with private life for employees.
Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.
OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in
Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.
OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in gen
Tasdemir Rabia; Sivri İsmail; Güzelordu Dilsat; Yener Mehmet Deniz; Aksu Elif; Colak Serap; Bamac Belgin; Colak Tuncay
The Anatomy is the most basic lecture of the departments that give health education. The human anatomy is need to be comprehended to success in nursing field. Anatomy subjects are taught independently in each committee in Nursing Department that is in School of Health in Kocaeli University. The aim of our study is assessment of the impact of the Anatomy lectures on Anatomy Self-Efficacy Beliefs of nursing students. Totally 95 students (mean of ages 19,13 ± 1,595) who are 25 boys (%26,3) and 7...
Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.
Zinn, J S; Weech, R J; Brannon, D
To examine the contextual attributes that influence nursing home TQM adoption, as informed by resource dependence and institutional theories. A survey of licensed nursing home administrators in the Commonwealth of Pennsylvania during 1994-1995, the Medicare and Medicaid Annual Certification Survey (MMACS) data file, and the Area Resource File (ARF). Because the dependent variable (TQM adoption vs. non-adoption) is dichotomous, the model was estimated using logistic regression. Of the 615 facilities that were mailed surveys, 241 (39.2%) returned completed questionnaires. No significant differences were observed between respondents and nonrespondents in size, for-profit status, system membership, registered nurse staffing, cited licensure deficiencies, Medicare census, or Medicaid census. Perceived competition, Medicare's share of total hospital discharges in the market, and facility Medicare census were significant predictors of TQM adoption. Our results provide limited support for the association between some rational adaptive and institutional factors and TQM adoption in nursing homes. Perceived competition and the influence of the Medicare program both at the facility and the market level are associated with TQM adoption. However, other factors associated with TQM adoption in other industries, such as size, are not associated with TQM adoption in the nursing homes in this study.
Mahdavi, A; Nikmanesh, E; AghaeI, M; Kamran, F; Zahra Tavakoli, Z; Khaki Seddigh, F
Nurses are the most significant part of human resources in a sanitary and health system. Job satisfaction results in the enhancement of organizational productivity, employee commitment to the organization and ensuring his/ her physical and mental health. The present research was conducted with the aim of predicting the level of job satisfaction based on hardiness and its components among the nurses with tension headache. The research method was correlational. The population consisted of all the nurses with tension headache who referred to the relevant specialists in Tehran. The sample size consisted of 50 individuals who were chosen by using the convenience sampling method and were measured and investigated by using the research tools of "Job Satisfaction Test" of Davis, Lofkvist and Weiss and "Personal Views Survey" of Kobasa. The data analysis was carried out by using the Pearson Correlation Coefficient and the Regression Analysis. The research findings demonstrated that the correlation coefficient obtained for "hardiness", "job satisfaction" was 0.506, and this coefficient was significant at the 0.01 level. Moreover, it was specified that the sense of commitment and challenge were stronger predictors for job satisfaction of nurses with tension headache among the components of hardiness, and, about 16% of the variance of "job satisfaction" could be explained by the two components (sense of commitment and challenge).
Ausserhofer, Dietmar; Schubert, Maria; Desmedt, Mario; Blegen, Mary A; De Geest, Sabina; Schwendimann, René
Patient safety climate (PSC) is an important work environment factor determining patient safety and quality of care in healthcare organizations. Few studies have investigated the relationship between PSC and patient outcomes, considering possible confounding effects of other nurse-related organizational factors. The purpose of this study was to explore the relationship between PSC and patient outcomes in Swiss acute care hospitals, adjusting for major organizational variables. This is a sub-study of the Swiss arm of the multicenter-cross sectional RN4CAST (Nurse Forecasting: Human Resources Planning in Nursing) study. We utilized data from 1630 registered nurses (RNs) working in 132 surgical, medical and mixed surgical-medical units within 35 Swiss acute care hospitals. PSC was measured with the 9-item Safety Organizing Scale. Other organizational variables measured with established instruments included the quality of the nurse practice environment, implicit rationing of nursing care, nurse staffing, and skill mix levels. We performed multilevel multivariate logistic regression to explore relationships between seven patient outcomes (nurse-reported medication errors, pressure ulcers, patient falls, urinary tract infection, bloodstream infection, pneumonia; and patient satisfaction) and PSC. In none of our regression models was PSC a significant predictor for any of the seven patient outcomes. From our nurse-related organizational variables, the most robust predictor was implicit rationing of nursing care. After controlling for major organizational variables and hierarchical data structure, higher levels of implicit rationing of nursing care resulted in significant decrease in the odds of patient satisfaction (OR=0.276, 95%CI=0.113-0.675) and significant increase in the odds of nurse reported medication errors (OR=2.513, 95%CI=1.118-5.653), bloodstream infections (OR=3.011, 95%CI=1.429-6.347), and pneumonia (OR=2.672, 95%CI=1.117-6.395). We failed to confirm our
Yang, Lixin; Lu, Yang; Wang, Liying; Chang, Fengqi; Zhang, Jianbo; Liu, Yinping
Eight PBDE congeners, BDE-28, 47, 99, 100, 153, 154, 183 and 209, were measured using gas chromatography coupled to mass spectrometry. The concentrations of Σ8PBDEs ranged from 0.04 to 19.93 ng g(-1) lipid weight (lw), with median and mean value of 1.21 and 2.72 ng g(-1) lw. PBDE congeners were detected in approximately 90 % of samples with BDE-209 as the dominant one. No significant correlations were found between the mothers' age, body mass index and PBDEs concentrations. We estimated the infant's dietary intake of the studied PBDEs via human milk during different nursing durations, and found that babies younger than 1 month might take a relatively higher body burden of PBDEs. The median levels of Σ8PBDEs were 0.74, 2.80, 2.43 and 0.90 ng g(-1) lw in colostrum, milk sampled at 1, 3 and 6 months after birth, respectively. High consumption of animal-origin food after birth may lead to the elevated ΣPBDEs concentrations in breast milk. A rational nutrition deployment is essential for postpartum mother.
Laura Carretero Cortes
Full Text Available The assessment of patient satisfaction allows one the one hand to identify deficient areas from the point of view of the patient and on the other hand to evaluate the care outcomes.Patient´s opinion is an essential component in the assessment of the service. If patients are dissatisfied, care is far away from what it should be, no matter how high quality can be assesed through clinical indicators.The objective was to determine the patient satisfaction´s level with the schedule established in the hospital. Thus, a descriptive study that using simple random sampling the elements of the random sample were chosen directly in one step, assign each person hospitalized in a hospital in Toledo BZH a number and through a mechanical means (balls in a bag we get random items that will be part of the sample (50 patients in the Hospital of Toledo BZH, so that each element in the population had an equal chance of being selected. The survey provides a closed, compilation, anonymous and voluntary.Results points to a certain degree of dissatisfaction among users, strict schedules and adapted to the "rotation" of health personnel, not patients.Analyzing the results in the development of activity schedules nursing activities: hygiene, feeding, etc ... we can see a big difference being a high percentage of patients who would prefer to change some schedules.
Abdar, Mohammad Esmaeili; Rafiei, Hossein; Abbaszade, Abbas; Hosseinrezaei, Hakimeh; Abdar, Zahra Esmaeili; Delaram, Masoumeh; Ahmadinejad, Mehdi
Providing high-quality care in the intensive care units (ICUs) is a major goal of every medical system. Nurses play a crucial role in achieving this goal. One of the most important responsibilities of nurses is sedation and pain control of patients. The present study tried to assess the effect of nurses' practice of a sedation protocol on sedation and consciousness levels and the doses of sedatives and analgesics in the ICU patients. This clinical trial was conducted on 132 ICU patients on mechanical ventilation. The patients were randomly allocated to two groups. While the control group received the ICU's routine care, the intervention group was sedated by ICU nurses based on Jacob's modified sedation protocol. The subjects' sedation and consciousness levels were evaluated by the Richmond Agitation Sedation Scale (RASS) and the Glasgow Coma Scale (GCS), respectively. Doses of administered midazolam and morphine were also recorded. The mean RASS score of the intervention group was closer to the ideal range (-1 to +1), compared to the control group (-0.95 ± 0.3 vs. -1.88 ± 0.4). Consciousness level of the control group was lower than that of the intervention group (8.4 ± 0.4 vs. 8.8 ± 0.4). Finally, higher doses of midazolam and morphine were administered in the control group than in the intervention group. As nurses are in constant contact with the ICU patients, their practice of a sedation protocol can result in better sedation and pain control in the patients and reduce the administered doses of sedatives and analgesics.
Kelly, Lesly A.; McHugh, Matthew D.; Aiken, Linda H.
The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non-Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = −5.29, P < .001) and more highly educated nurses (t = −2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P < .05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout. PMID:22976894
Hardy, J L
The aim of the study was to determine the perceptions of students entering nursing at the bachelors level, of their actual and desirable knowledge about computers and their applications relevant to nursing and health care. Within the health care system the use of computerized systems is increasing rapidly. In Australia, the NSW Health Department's Information Management Resource Consortium pilot project--to introduce the First Data Hospital Information System into NSW public hospitals--is a significant example of this trend. While the importance of computerized systems is fairly well recognized for the areas of management and research, they are becoming increasingly significant in the delivery of clinical care and quality assurance. It is important that nurses during their undergraduate education develop the computer literacy and awareness that will allow them access to the both the information and its management. To achieve this effectively it is essential to determine both the entry knowledge of students and what skills and knowledge are essential and desirable for their future roles as nurses. The research undertaken replicated an American study  and used their validated questionnaire. Both pre-registration(n=20) and post-registration (n=24) undergraduate students responded to a 21 item questionnaire. The issues addressed related to computer literacy, usage, and knowledge of clinical applications. Both groups desired more "hands on" experience and knowledge in the nurse's role in developing applications and using computers to help care for patients. These results were consistent with the Parks et. al. study. The significance of comparing actual and desirable levels of computer knowledge and awareness is in assisting educators to shape curriculum and course content to more effectively meet the educational needs of these groups in terms of Health Informatics.
... background in making eligibility and funding determinations generally make awards to: Accredited schools of medicine, osteopathic medicine, public health, dentistry, veterinary medicine, optometry, pharmacy, allied health, podiatric medicine, nursing, chiropractic, public or private nonprofit schools which offer...
Full Text Available This study was conducted to determine patients’ satisfaction with nursing care and health services. This descriptive study was performed with 320 inpatients at University Hospital’s internal diseases and surgical units in July and November 2011. The data were collected by a questionnaire and the Visual Analog Patient Satisfaction Scale and the Scale of Patient Perception of Hospital Experience With Nursing. For statistical evalution , SPSS(Statistical Package for Social Science 15 percent by using the program, the Student t-test, ANOVA and Kruskal- Wallis analysis was done with. The mean total score was 8.65±1.52 on the Visual Analog Patient Satisfaction Scale. The Scale of Patient Perception of Hospital Experience With Nursing, the mean total score was 65.90±11.00. Consequently, Patients were satisfied with the nursing care and health services. [TAF Prev Med Bull 2012; 11(6.000: 717-724
Abstract Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods\\/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of
Abstract Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods\\/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of
目的 探讨护士分层级加绩效管理在门诊护理管理中的应用效果.方法 对门诊护士进行岗位分层级管理,将各岗位制度、流程、职责重新修订,并对各层级护士的业务能力、服务质量、工作态度、考勤等进行绩效考核,评分总数与奖金和评优评先挂钩.结果 实施后患者的等候时间较实施前显著缩短,且患者满意度、护理质控及护理人员考核率等较实施前有所提高,差异均有统计学意义(P＜0.01).结论 实施护士分层级加绩效管理后,护理质量和患者满意度均提高,护理投诉量下降,同时还提升了护士的综合素质和规范了护理管理工作.%Objective To explore the effect of management of nurses with different levels of professional skills and performance appraisal on nursing management of outpatient department.Methods Nurses in outpatient department were managed according to their different levels of professional skills,and the job system,work process and duties and responsibilities were revised.Performance appraisal was used to judge the ability,quality of nursing service,attitude and work attendance,and the total score was a reference standard for assessment of bonus and selection of prominent people.Results After the implementation of management of nurses with different levels of professional skills and performance appraisal,patients' waiting time shortened significantly,and patients' satisfactory degree toward nursing,nursing quality and nursing assessment rate improved significantly (P ＜ 0.01).Conclusion After the implementation of management of nurses with different levels of professional skills and performance appraisal,the nursing quality and patients' satisfactory degree toward nursing improve significantly,and nursing complaints decrease; meanwhile,nurses are able to promote their comprehensive qualities and the nursing management is able to be more normalized.
Arturo Juárez García
Full Text Available The Occupational Health Nursing practice is an emergent area in Mexico, nevertheless, in other countries the nurses are the most frequent profession in this field. It is necessary increase the educative options in this practice under the best vanguard standards like the competencies system. There are evidences that show nurses as the professionals with the least competencies compared with others professionals, mainly in developing countries. In Mexico there are no standardized competencies in occupational health nursing, as well as studies about the competencies in nurses in this field and its relationship with demographic variables and occupational health indicators. In this way, it was designed a study with the following objectives: 1 To adapt and set up standardized competencies in this practice in Mexico, 2 To assess competences in nurses whose job is carried out in type III and IV companies, 3 To determine if there are differences in the competencies according to the demographic factors, and 4 To determine if there are a relationship among the competencies and key indicators of the occupational health services, such as the accident rates, “incapacities” (compensations ,and the number of medical attending at workplace.
Chen, Chao-Huei; Huang, Li-Chi; Liu, Hsin-Li; Lee, Ho-Yu; Wu, Shu-Ya; Chang, Yue-Cune; Peng, Niang-Huei
(1) To explore attitudes and beliefs of neonatal nurses toward nursing care for dying neonates; (2) to estimate the influence of neonatal nurses' personal and professional characteristics on their attitudes towards end-of life care for dying infants. A cross-sectional design was used. A questionnaire was used to collect data from 80 neonatal nurses. Research setting was four level III NICUs at four medical centers around the central region of Taiwan. Research participants were neonatal nurses who had worked for at least 1 year in one of level III NICUs and had been directly involved with the care of dying infants. Research participants were 80 neonatal nurses (response rate 100 %). Research findings identified eight barriers hindering neonatal palliative care practice. These barriers were insufficient communication due to the lack of an in-service educational program; the lack of available counseling help for neonatal clinicians; inability to express personal opinions, values and beliefs towards neonatal palliative care; insufficient staffing; the lack of unit policies/guidelines for supporting palliative care; the technological imperative; parental demands and personal beliefs about death and previous experience caring for dying infants. Further studies are needed to explore each barrier and to provide in-service neonatal palliative care educational programs that are needed to decrease these barriers.
Bai, J Y; Suh, M J
This study was designed to measure the degree of work stress perceived by clinical nurses working in psychiatric ward, and to identify the factors influencing the difference of work stress. The survey method was used and the subjects of this study consisted of 135 psychiatric nurses from 7 university hospitals and 4 provincial general hospitals. The data were collected from August 1 to 20, 1988. The instrument used for this study was PNOSS (Psychiatric Nurse Occupational Stress Scale) which was developed by Bai (1989). The confidence verification of this instrument was computed and the Cronbach alpha was 0.94050. Data were analysed by t-test and ANOVA on 5% significant level with SPSS program. The results of study were summarized as follow: 1) The degree of perceived stress among psychiatric nurses was considerably high (4.32 out of 6.00). 2) Among the stressors, inadequate staffing (5.04), hospital administration problems (4.7) and the conflict of nurse-patient relationship were identified as the stress factors with high rank of degree of stress. 3) There was significant relationship between the degree of stress and the demographic variables of nurses such as the marital status, educational level, and the motivation of working in psychiatric ward. 4) There was significant relationship between the job-related variables such as the working duration, the motivation of working and nurse's attitude toward the psychiatric patients. 5) The relationship between several stress factors and some of the demographic and the job-related variables were significantly identified.
Keigher, Sharon M.
Considers article written by professor of social welfare in 1981 in which job security of social workers is addressed. Compares views expressed in 1981 with situation faced by social workers today. Considers danger of administration costs resulting in short-staffing of hospitals serving the poor and discusses case of 22-year-old obstetrics patient…
... requirements. (a) The organizational structure of the IV-D agency (see § 302.12) provides for administration or... supervisory authority. (b) There is an organizational structure and sufficient staff to fulfill the following... 45 Public Welfare 2 2010-10-01 2010-10-01 false Minimum organizational and staffing requirements...
... 32 National Defense 4 2010-07-01 2010-07-01 true NEPA analysis staffing. 651.6 Section 651.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY... depth of analysis required. In cases where the document addresses impacts to an environment...
Conley, Valerie Martin
The model of staffing in higher education proposed by Winston and Creamer (1997) includes essential components of recruitment and selection, orientation, supervision, staff development, and performance appraisal. Proposes that the model has a significant oversight-when staff leave their position. Separation is proposed as a necessary component of…
Salt, John; Wood, Peter
This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…
Whitchurch, Celia; Gordon, George
Higher education managers are under increasing pressure from governments to reduce costs by adopting more flexible staffing practices and tensions can arise as institutions seek to sustain motivation and morale across a diversifying workforce. This paper considers how institutional management and governance practices facilitate innovative…
Goldsack, Jennifer C; Robinson, Edmondo J
Hospitals nationwide must demonstrate meaningful use by 2015 or face fines. For over 20 years, researchers have attempted to assess the impact of electronic record keeping technologies on the quality, safety, and efficiency of care, but results are inconclusive and hospital managers have little evidence on which to base staffing decisions as we hurtle toward the era of the paperless hospital.
Pulliam, Cheryl L.; LaCaria, Lynne; Schoeneberger, Jason; Algozzine, Bob
The authors evaluated a reform program known as "Strategic Staffing" in which principals were given increased autonomy to modify the delivery of instruction without compromising academic content. The program's central feature was reassignment of school leaders and key staff members from settings in which they were successful to…
Jönsson, Kenneth; Fridlund, Bengt
Priority or triage has always occurred in emergency care. Today it is performed by both nurses in emergency departments (EDs) and ambulance services (ASs) to ensure patient safety. Recent studies have shown that nurses are unlikely to change their first impressions and patients suffering from blunt trauma are undertriaged. Our study aimed to compare and evaluate the adherence to correct triage level documentation, between nurses in the ED and the AS, according to current regulations. Of 592 analysed triage records from a university, a central and a district hospital, the adherence was 64% by ED nurses and 43% by AS nurses (pnurses do not adhere to the triage system and do not correctly document the triage level. Internal feedback and control are two approaches to improve the patient outcome, indicating that organisational actions must be taken.
Puentes, William J; Bradway, Christine K; Aselage, Melissa
Within the older adult population, certain idiosyncratic aspects of mental illness add to the challenges of helping clients manage these disorders. Older adults are more likely than younger populations to experience physiologically based comorbidities, a dynamic that further strains coping capacities. Barriers to the provision of comprehensive mental health nursing care for older adults include myths and stigmas about aging and mental health. Nurse educators are challenged to move students toward a more positive, empirically based approach to the care of older adults' mental health. In this article, background information supporting the importance of working to improve students' knowledge of and attitudes toward mental illness in older adults is provided. Specific teaching strategies in the areas of older adult mental health, dementia, and delirium are discussed. Resources to support the incorporation of these strategies into nursing curricula are described.
Glenda S Reemts
Full Text Available Objective: The increasing complexity of the healthcare environment calls for increasing emotional intelligence (EI competence in nurses. This study assessed the EI competence of 164 baccalaureate nursing alumni who graduated during the years 2007-2010 from three Benedictine institutions located in the Midwestern United States to see if there was growth of EI with experience as a registered nurse (RN, and to determine if age, gender, grade point average (GPA, and years of total healthcare work experience prior to graduation predicted EI. Methods: Participants completed the web-based Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT and a demographic survey. Results: Findings indicated 79.4% of participants were competent or higher on the MSCEIT total EI score. Percentages of nurses scoring in the competent or higher range on each of the four branch scores of perceiving, using, understanding and managing emotions were 80.6%, 72.7%, 84.2%, and 84.9% respectively. There were no significant differences on EI scores between graduates with 1-2 years compared to 3-5 years of experience as a RN. Results of a linear stepwise regression indicated being female was a significant predictor on the MSCEIT total EI score (P = 0.015 and using emotions branch (P = 0.047. Findings also indicated GPA (P < 0.001 and being female (P = 0.023 were significant predictors of EI on the understanding emotions branch. Conclusions: The findings indicate there is work to be done to improve the EI competence of nursing graduates. Continued research on the topic of EI and nursing is needed to build the knowledge base on how to promote positive patient outcomes.
赵小红; 侯君; 刘晓梅; 张瑞娟
目的：探讨主要护师主导的护理查房在护士分层次培训中的应用效果。方法2013年1～12月采取传统的护理查房模式（改进前），2014年1～12月采取主管护师主导的护理查房（改进后），由主管护师主导，小组内多人分工完成护理查房中问诊、查体、提出护理诊断、护理措施、查房总结等环节，并增加主管护师专题讲座、护理追踪评价反馈环节。比较改进前后的护理查房效果和护士护理考核成绩。结果改进年后，护理查房效果明显提高，其中查体沟通、护理分析、概括总结等评分均显著优于改进前，前后比较，均P＜0．05，差异具有统计学意义；护士各方面考核成绩均优于改进前，前后比较，均P＜0．01，差异具有统计学意义。结论主管护师主导的护理查房，能有效提高护理查房效果，提高各层次护理人员发现、分析、解决问题的临床综合能力和专科能力。%Objective To explore the effect of nurse-in-charge-led ward rounds on the multi-level training of nurses. Methods The traditional nursing ward round was adopted from Juanuary to December 2013 and the nurse-in-charge-led ward round was adapted from January to December 2014. The nurse-in-charge-led round mode and flowchart was developed by designating one nurse-in-charge to carry out the process of nursing round and other nurses in the group to carry out nursing interrogation, check-up, physical examination, nursing diagnosis, making nursing strategy and conclusion. Additionally, the two links of nurse-in-charge-led seminar and nursing feedback were added in the nursing round. The effect of nursing ward round and the results of nursing examination were compared between before and after the improvement. Results A year after implementing new nursing round mode, the effect of nursing round was significantly better than that before the implementation of new mode and the nursing
Arends, Richard I.; Essig, Don M.
This report is the first in a series describing the background, theory, and progress of the Differentiated Staffing Project in the Eugene, Oregon, School District. This particular report reviews the history of the project and outlines the organizational structure that has emerged and developed in the experimental elementary schools. A number of…
Jones, Aled; Lankshear, Annette; Kelly, Daniel
Recent reports into egregious failing in the quality and safety of healthcare in the UK have focussed on the ability of executive boards to discharge their duties effectively. Inevitably the role of executive nurses, whose remit frequently includes responsibility for quality and safety, has become the object of increased scrutiny. However, limited evidence exists about the experiences of the UK's most senior nurses of working at board level. We aimed to generate empirical evidence on the experiences of executive nurses working at board level in England and Wales. We posed two research questions: What are the experiences of nurse executives working at board level? What strategies and/or processes do nurse executives deploy to ensure their views and concerns about quality and safety are taken into account at board level? Qualitative interviews using semi-structured interviews. NHS England and Wales. Purposive sample of 40 executive board nurses. Semi-structured interviews followed by a process of thematic data analysis using NVivo10 and feedback on early findings from participants. Our findings are presented under three headings: the experiences of executive nurses working with supportive, engaged boards; their experiences of being involved with unsupportive, avoidant boards with a poor understanding of safety, quality and the executive nursing role and the strategies deployed by executive nurses to ensure that the nursing voice was heard at board. Two prominent and interrelated discursive strategies were used by executive nurses - briefing and building relationships and preparing and delivering a credible case. Considerable time and effort were invested in these strategies which were described as having significant impact on individual board members and collective board decision making. These strategies, when viewed through the lens of the concept of "groupthink", can be seen to protect executive nurses from accusations by board colleagues of disloyalty whislt also
Valls-Ibáñez, Victoria; Fernández-Obispo, Matilde; Torralbas-Ortega, Jordi; Bernal-Jiménez, Montserrat
Spain is one of the countries where most solid organ transplants are performed each year, in the year 2014 a 2.7% of them were given in childhood. Given the complexity and severity of this disease it is necessary to establish a care plan that covers both pre-transplant and post-transplant, with close cooperation between different levels of care, to approach the several problems that can appear and assure continuum of care. In the following example, a Gambian teen with risk of social exclusion fostered a collaboration between the primary care nurse and transplant nurse that was the key to continuum care. Multiple strategies were used in the care plan to ensure better adherence and compliance of the treatment. However, the knowledge of the culture of origin must be deepened to establish more individualized care plans and thus improve results. The care plan included problems according to the NANDA, NOC, NIC taxonomy.
Calder Calisi, Catherine
The purpose of this pilot study was threefold: to teach nurses the Relaxation Response ( RR), a relaxation technique created by Benson; to measure the effects of the RR on nurses' levels of anxiety, depression, well-being, and work-related stress; and to explore nurses' confidence in teaching their patients the RR. A wait-list, randomized-control quantitative study design was used. Nurses in the intervention group were trained on the benefits and the technique of the RR and were then asked to practice the RR over an 8-week period. No statistical significance was found in nurses' reported level of anxiety, depression, well-being, and work-related stress. However, the nurses reported greater confidence in teaching this technique to patients ( p < .001). As a strategy for self-care in the workplace, nurses were receptive to learning the RR and reported confidence in using this strategy for their patients. Larger studies may reveal more significant reductions in workplace stress and anxiety for nurses.
Nurses in ICU nursing work is often accompanied by a lot of pressure, because of ICU patients with the disease is severe, the nurse to 24 hours to continuous monitoring of patients, for patients with sudden serious illness, the nurse to take measures in the first time, save the life of the patients, nurses should not only work for a long period of time, but also to monitor the vital signs in patients with moment, to prevent the occurrence of accidents, so the nurse because of work pressure big, often can produce low moods, lead to the nurse's work efficiency is affected. Level of nursing management mode application can effectively improve the enthusiasm of nurses, improve the quality of nursing work, guarantee the effi-ciency of patient care.%护士在ICU护理工作中往往伴随着很大的压力，因为ICU的患者病情严重，护士要24 h对患者进行不间断监护，对于突发严重病情的患者，护士要在第一时间采取处理措施，挽救患者的生命，所以护士由于工作压力大，经常会产生低落的情绪，导致护士的工作效率受到影响。层级护理管理模式的应用能够有效提高护士的积极性，提高护士工作质量，保障了患者的治疗效率。
Phelan, Amanda; Mccarthy, Sandra; Adams, Elizabeth
To examine the prevalence of missed care in the community nursing. Previous studies have used a missed care framework to identify challenges routine nursing care in acute care environments. Several issues related to quality of care, safe staffing, job satisfaction and poor teamwork. However, this concept has not been examined in the community nursing context. A cross-sectional survey design was used to explore the concept of missed care in community nursing using demographical information, community nursing roles and reasons for missed care. Online questionnaires were completed by 458 community nurses in the Republic of Ireland to determine the prevalence of and reasons for missed care (31 July -25 September 2015). With a response rate of 29%, findings were above 70 percent in several routine care responsibilities. Other findings point to a higher level of missed care in nurses who had less than five years' experience and other variables such as age, those who worked additional unpaid hours and there were some regional variations. The results of the study indicate a high prevalence of missed care in the community nurses surveyed and that preventative care was the type of care most likely to be missed. This has serious implications for a nursing service that is preventative in nature and suggests that the missed care framework could benefit workforce planning for community nursing services both in Ireland and elsewhere. Accordingly, policy, practice and educational reforms are fundamental to meet current and future population needs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Gullo, Shirna R.
Computerized testing may be one solution to enhance performance on the curricular Health Education Systems Inc. (HESI) exam and the National Council Licensure Exam for Registered Nurses (NCLEX-RN). Due to the integration of improved technological processes and procedures in healthcare for computerized documentation and electronicmedical records,…
Rogerson, Elizabeth C. B.; Harden, Ronald M.
At the University of Dundee (Scotland), distance learning is used to provide inservice opportunities for nurses and midwives. The modular courses feature problem-based and work-based learning, text-based study guides, and strategies to provide continuous learner support. (SK)
The purpose of this study was to develop and evaluate a mentorship program for freshman nursing students enrolled in a diploma program. This phenomenological research study utilized several processes in data analysis and interpretation: (a) a comprehensive literature search, (b) development of a mentorship model using a 7-step process for data gathering and interpretation, (c) development of an education module for mentors, (c) the use of an existing validated survey, (d) development of 3 surveys, and (e) administration of the surveys. Results of the study indicated that the mentorship program should be part of the Mercy School of Nursing (MSON) curriculum as an elective rather than a requirement for all freshman nursing students. In addition, the effects of mentorships should be examined in terms of (a) retention rates, (b) productivity, (c) employee satisfaction, and (d) cost. Also, the mentorship program should be extended to the nursing staffs at other health care facilities that accommodate MSON students. Finally, future research of this topic should be more extensive and include a larger sample size to offset the effects of student attritions during their semesters.
McAlpine, Heather; Lockerbie, Linda; Ramsay, Deyanne; Beaman, Sue
Student and teacher opinions were obtained regarding a Web-based ethics course for nursing graduate students. Both groups had positive views of online discussions; critical and reflective thinking was enhanced; technical difficulties were overcome with the help of expert support services; compressed time frame was a drawback; and ways to enhance…
McGregor, Margaret J; Murphy, Janice M; Poss, Jeffrey W; McGrail, Kimberlyn M; Kuramoto, Lisa; Huang, Huei-Chung; Bryan, Stirling
RÉSUMÉ La législation, dans de nombreuses juridictions, nécessite les établissements des soins de longue durée (SLD) d'avoir une infirmière en service 24 heures par jour, 7 jours par semaine. Bien que la recherche considérable existe sur l'intensité SLD de la dotation en personnel infirmier, il n'existe pas de la recherche empirique relative à cette exigence. Notre étude rétrospectif d'observation a comparé des installations en Saskatchewan avec 24/7 RN couverture aux établissements offrant moins de couverture, complétées par divers modèles de dotation des postes de nuit. Les ratios de risque associés à moins de 24/7 couverture RN complété de la dotation infirmière autorisé de nuit, ajusté pour l'intensité de dotation en personnel infirmier et d'autres facteurs de confusion potentiels, étaient de 1,17, IC 95% [0,91, 1,50] et 1.00, IC à 95% [0,72, 1,39], et avec moins de couverture 24/7 RN complété avec soin par aides personnels de nuit, les ratios de risque étaient de 1,46, IC 95% [1,11, 1,91] et 1,11, IC 95% [0,78, 1,58], pour les patients hospitalisés et de visites aux services d'urgence, respectivement. Ces résultats suggèrent que l'utilisation des soins de courte durée peut être influencée négativement par l'absence de la couverture 24/7 RN.
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Huda M. Al-Makhaita
Full Text Available Introduction: Work-related stress (WRS is an insidious and persistent part of everyday life related to the response of people to work environment. Nursing is a strenuous job and WRS is prevalent among nurses. The aim of this study was to estimate the prevalence of WRS among nurses working in primary and secondary health care levels in Dammam, Eastern Saudi Arabia. Materials and Methods: A cross-sectional epidemiological study was conducted in 17 primary health care centers (PHCCs representing the primary level of health care and Medical Tower Complex (MTC representing the secondary health care level in Dammam city. The total number of nurses included in the study was 637 nurses (144 in PHCCs and (493 MTC. Data were collected using a self-administered questionnaire, which was developed based on the pertinent literature. It included two main parts: Sociodemographic and job characteristics of nurses and 31 WRS questions. Results: The overall prevalence of WRS among all studied nurses was 45.5%; 43.1% and 46.2% in primary and secondary levels, respectively. In the primary level, there was a statistical significant association between WRS and being married (85.5%, and having living three children and more (53.2%. Moreover, younger age group 20-<30 years (79.4%, Saudi nationality (86.8%, being married (74.6%, having nonbachelor degree (83.3%, work shifts (89.5%, and working in surgical department (46.5% were the significant associating factors with the occurrence of WRS among nurses in secondary levels. Young age was the only predicting factor for WRS in primary care level. While being female, Saudi, married, with work shifts, and working in surgical department were found to predict WRS in the secondary level. Recommendations: Appropriate strategy in health care organization to investigate stress in health care settings is recommended. Moreover, interventional programs to identify, and relieve sources and effects of stress should be developed.
目的：了解江苏省某市三级甲等医院护士护理伦理知识水平调查并分析其影响因素。方法采用自制护士对护理工作中常用的护理伦理知识了解情况问卷，对按年龄﹑工作时间分层抽取的200名护士进行调查。结果100%的护士认为高尚的职业道德对护理人员来讲是必要条件；44%的护士自评护德不高；只有17%的护士认为自身的伦理学知识较多；45%护士不知道护理的本质是关爱；39%护士不知道护理伦理知识会影响护患关系。学历越高﹑护龄越长﹑职称越高﹑已婚护士对护理伦理准则因子认知水平越高(P<0.05)；学历越高﹑已婚护士对护理工作中护理关爱因子认知水平越高(P<0.05)；护龄﹑职称护士对是否关爱病人无影响。结论临床护士的护理伦理知识水平较低，需要进一步提高，应不断加强护士护理伦理学知识的再教育，进行系统培训，提高伦理决策能力，形成正确的伦理道德观和专业精神。%Objective To understand the Jiangsu province city three Jiadeng hospital nurses ethical knowledge level survey and analysis the influencing factors. Methods Using self-made nurses nursing in nursing ethics common knowledge to un-derstand the situation of investigation questionnaire, according to age, work time stratified 200 nurse. Results 100% of nurs-es thought that noble professional ethics in terms of nursing staff is a necessary condition; 44% of the nurses self-assess-ment door De is not high; only 17% of the nurses think their ethics knowledge more; 45% of the nurses do not know the essence of nursing care;39%nurses do not know the knowledge of nursing ethics will influence the relations between nurse and patient. Higher education, nursing age longer, higher professional title, married nurses on nursing ethics factor cognitive level higher (P< 0.05); higher education, married nurses cognition level of nursing work in nursing care factor
van Oostveen, Catharina J; Vermeulen, Hester; Nieveen van Dijkum, Els J M; Gouma, Dirk J; Ubbink, Dirk T
Surgeons and nurses sometimes perceive a high workload on the surgical wards, which may influence admission decisions and staffing policy. This study aimed to explore the relative contribution of various patient and care characteristics to the perceived patients' care intensity and whether differences exist in the perception of surgeons and nurses. We invited surgeons and surgical nurses in the Netherlands for a conjoint analysis study through internet and e-mail invitations. They rated 20 virtual clinical scenarios regarding patient care intensity on a 10-point Likert scale. The scenarios described patients with 5 different surgical conditions: cholelithiasis, a colon tumor, a pancreas tumor, critical leg ischemia, and an unstable vertebral fracture. Each scenario presented a mix of 13 different attributes, referring to the patients' condition, physical symptoms, and admission and discharge circumstances. A total of 82 surgeons and 146 surgical nurses completed the questionnaire, resulting in 4560 rated scenarios, 912 per condition. For surgeons, 6 out of the 13 attributes contributed significantly to care intensity: age, polypharmacy, medical diagnosis, complication level, ICU-stay and ASA-classification, but not multidisciplinary care. For nurses, the same six attributes contributed significantly, but also BMI, nutrition status, admission type, patient dependency, anxiety or delirium during hospitalization, and discharge type. Both professionals ranked 'complication level' as having the highest impact. The differences between surgeons and nurses on attributes contributing to care intensity may be explained by differences in professional roles and daily work activities. Surgeons have a medical background, including technical aspects of their work and primary focus on patient curation. However, nurses are focused on direct patient care, i.e., checking vital functions, stimulating self-care and providing woundcare. Surgeons and nurses differ in their perception of
Full Text Available Abstract Background Pressure ulcers are a common and serious health care problem in all health care settings. Results from annual national pressure ulcer prevalence surveys in the Netherlands and Germany reveal large differences in prevalence rates between both countries over the past ten years, especially in nursing homes. When examining differences in prevalence and incidence rates, it is important to take into account all factors associated with the development of pressure ulcers. Numerous studies have identified patient related factors, as well as nursing related interventions as risk factors for the development of pressure ulcers. Next to these more process oriented factors, also structural factors such as staffing levels and staff quality play a role in the development of pressure ulcers. This study has been designed to investigate the incidence of pressure ulcers in nursing homes in the Netherlands and Germany and to identify patient related factors, nursing related factors and structural factors associated with pressure ulcer development. The present article describes the protocol for this study. Methods/design A prospective multicenter study is designed in which a cohort of newly admitted nursing home residents in 10 Dutch and 11 German nursing homes will be followed for a period of 12 weeks. Data will be collected by research assistants using questionnaires on four different levels: resident, staff, ward, and nursing home. Discussion The results of the study will provide information on the incidence of pressure ulcers in Dutch and German nursing homes. Furthermore, information will be gathered on the influence of patient related factors, nursing related factors and structural factors on the incidence of pressure ulcers. The present article describes the study design and addresses the study's strengths and weaknesses.
Williams, G; Chaboyer, W; Thornsteindóttir, R; Fulbrook, P; Shelton, C; Wojner, A; Chan, D
While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.
Full Text Available Background: High intensity interval training (HIIT is a novel training method which has received most attention in recent years. The aim of this study was to examine the effect of 8 weeks of high intensity interval training (HIIT on plasma levels of adiponectin and leptin in overweight nurses.Materials and Methods: 27 nurses (mean age 25.81±60 years, height 158.01±67 cm and weight 69.41±25 kg were voluntarily selected and randomly assigned to three groups (each group 9 subjects: 1. HIIT (type 1 including 8 seconds of sprint running and 12 seconds of active recovery 2. HIIT (type 2 including 40-m shuttle run with maximum speed 3. Control group. HIIT (type 1 was performed for eight weeks, three sessions per week, each session 6-9 min. With more than 90% HRmax. HIIT (type 2 was applied for eight weeks, three sessions per week with more than 90% HRmax. The control group did not participate in any training protocol.Results: The data were analyzed by the dependent t test and ANOVA. The results showed that the HIIT (type 1 and (type 2 had significant effects on plasma leptin decrease and plasma adiponectin concentration increase in nurses. One-way analysis of variance (ANOVA was used to analyze the intergroup data at p˂0.05.Conclusion: The results showed a significant difference in the variables (leptin and adiponectin among HIIT (type 1, HIIT (type 2 and control.
Full Text Available Job burnout is defined as a syndrome - a complex product of emotional exhaustion, depersonalization and reduced personal achievements that can occur to people who work extensively with many other people under considerable time pressure. Aim: The investigation and measurement of factors contributing in the creation of stress and fatigue of nursing staff so as the satisfaction and self-esteem that nurses live during their professional career. Material and methods: The study population included 167 employees of regular nursing staff working in three public hospitals of the province. Data was collected by completing anonymous structured questionnaire. The program used for entering coded data and statistical processing was SPSS 11.0. Results: Statistical analysis showed that females reported "good" and "very good" emotional status than males with a statistically significant difference, p <0.001. Also, the men surveyed were satisfied with their profession 'often' and 'very often' compared with women with a statistically important difference, p <0.005. Τhe greater the seniority of the respondents the more they say that fatigue at the during the shift. The observed difference is statistically significant at a p level of less than 0.05. Finally there was little statistically significant positive correlation between years of work and fatigue. (p=0,004. Conclusions: Health professionals are more prone to fatigue than other professional workers because they are responsible for human lives and their actions have a significant impact on these people, the workload given to them is very high.
Huda, S; Cavey, A; Izat, A; Mattison, P; Boggild, M; Palace, J
In clinical trials drop out bias reduces the validity of results. This is a particular problem in long-term multiple sclerosis (MS) studies, particularly when patients become progressively disabled and have increasing difficulty attending assessment clinics. To assess the validity of nurse led telephone assessment of Expanded Disability Status Scale (TEDSS) in MS patients with EDSS scores >6.0. We performed a multi-centre, single blind trial to assess nurse derived TEDSS against physician face-to-face EDSS scores derived from neurological examination (FEDSS) in patients with clinically definite MS and EDSS >6.0. Ninety patients (n=15 primary progressive MS, n=74 secondary progressive MS, n=1 relapsing remitting MS) had a mean baseline FEDSS of 7.5. TEDSS correlated with FEDSS (r=0.76, pEDSS points, and within 1 EDSS point were 0.25, 0.86, and 1.0 respectively. Intra-class correlation between the scoring systems was 0.88, representing a high level of agreement. Nurse-led telephone assessment of EDSS gives good agreement with physician derived face-to-face EDSS in MS patients with higher disability scores. This may be a valuable tool to improve clinical follow-up in routine clinical practice and improve patient retention in long-term outcome studies. Copyright © 2016 Elsevier B.V. All rights reserved.
Lodge, N; Mallett, J; Blake, P; Fryatt, I
The Sex Discrimination Act lifted the barriers which prevented men from training and practising as midwives. However, cultural attitudes perceive nursing to be a female profession, and whilst care from a male doctor is considered to be acceptable, care from a male nurse is said to be embarrassing. The purpose of the study was to identify if there was any relationship between the intimacy of a nursing interaction and the patient's level of embarrassment. Data collection was by questionnaires with rating scales. Demographic data was obtained from nursing and medical notes. Statistical analysis was performed by non-parametric methods using Mini-tab. Ninety-one questionnaires were returned from a convenience sample of patients on a gynaecological oncology ward. Analysis of the data indicates that in a population of patients who have no prior experience of hospital admission, or of being cared for by a male nurse, there is a preference for care by a female nurse. However, this preference is not demonstrated in patients who have undergone previous hospital admission within the last five years or who have been cared for by a male nurse. These findings would indicate a cultural preference for care by a female nurse in patients with gynaecological cancer that is changed by experience during hospital admission.
Full Text Available Objective: The correct use of necessary equipment is the key for a successful noninvasive mechanical ventilation (NIMV practice. Trained health care personnel are important part of the practice. The current study was conducted to that end, with the aim of determining the level of knowledge about NIMV of nurses working in a training and research hospital as descriptive. Methods: The study was conducted with 147 nurses who are working at Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital in İstanbul. Questionnaire form of 36 questions prepared by investigators was used to collect data. For the analysis of the results, numerical, percentages, Mann-Whitney U and Kruskal Wallis tests were used.’ Results: 40.8% nurses had received training about NIMV. By contrast, 24.5% stated that they had learned NIMV practices on their own. The lowest rate (26.5% of correct answered question was “disadvantages of oronasal mask”. The most answered statement as true was “Face masks should be established to the patient’s face with no gaps for prevention of leaks and the mask should be worn not to pressure on nasal bridge” (78.9%. Female and postgraduate nurses‘ total scores obtained from NIMV questions were higher than others and were statistically significant (p<0.05. Conclusion: The effective NIMV practices requires trained personnel. Nurses who have active role in NIMV practices should receive basic training in this topic. How will be started treatment, indications, who will be responsible for follow-up and points to take into consideration are mentioned clearly in the training program. This training programme should include processing of clinical experience as well as theoretical information.
Perdue, Mary K. CAPT; Rothacker III, John A. CAPT Cc: Palarca, Christine, LT, USN, OASD(HA)/ TMA ; Johnson, Scott A.CDR BUMED; Chalker, Newton J LCDR...research project. r/CAPT Lyons CAPT Kim Lyons, NC, USN Assistant Deputy Chief of Staff, Personnel ( MIC ) Deputy Director, Navy Nurse Corps (MIC5) 2300...USN, OASD(HA)/ TMA Sent: Monday, September 11, 2006 2:51 PM To: Swisshelm, Daniel M. (LCDR); Winborne, Renee F CIV NNMC; Buchanan, Bradley D LCDR
Depasse, B; Pauwels, D; Somers, Y; Vincent, J L
To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to be passed on to the nurse-in-charge of their ICU. 156 completed questionnaires were analyzed: 49% were from university hospitals, 26% from university-affiliated hospitals, and 25% from community hospitals; 42% of the hospitals had more than 700 beds, 67% of the ICUs had between 6 and 12 beds, and 54% were mixed medical-surgical units. Among British units, 79% had more than three full-time nursing equivalents (FTE) per ICU bed, while in Sweden 75% of units had less than two FTE/ICU bed. University hospitals had more nursing staff per bed than community hospitals. As regards training, 33% of nurses followed a training course before starting work on the ICU and 64% after starting on the unit, and 85% had easy access to continuing education, particularly in the university hospitals. In an emergency, more than 70% of nurses regularly initiated oxygen administration, mask ventilation, or cardiac massage. In Sweden 100% of nurses and in Switzerland 91% of nurses regularly inserted peripheral intravenous catheters, but only 7% of German nurses did. No German nurses and only 12% of British nurses regularly performed arterial puncture, but in Sweden 75% of nurses regularly did. Even though the number of participants were limited, our questionnaire revealed variations in nurse staffing patterns among European countries and in their systems of training and education. Nurse autonomy also varies widely between countries.
Full Text Available Abstract Stress is a state of emotional cognitive behavioral and physical reactions to unfavorable situations and is characterized by high levels of arousal distress and feelings of not coping. It has major behavioral and health implications. Stress has a special significance in health care where the workers experience both psychosocial and physical stress. As front-line health care workers who are in the wards for twenty four hours a day Nursing Officers are at high risk of stress due to their enormous responsibilities. In the ward setting they act as the link between the physicians patients and the community.
Full Text Available Purpose: This paper introduces a procedure for solving the staffing problem in a service system (i.e., determining the number of servers for each staffing period. Design/methodology: The proposed algorithm combines the use of queueing theory to find an initial solution with the use of simulation to adjust the number of servers to meet previously specified target non-delay probabilities. The basic idea of the simulation phase of the procedure is to successively fix the number of servers from the first staffing period to the last, without backtracking. Findings: Under the assumptions that the number of servers is not upper-bounded and there are no abandonments and, therefore, no retrials, the procedure converges in a finite number of iterations, regardless of the distributions of arrivals and services, and requires a reasonable amount of computing time. Originality / value: The new procedure proposed in this paper is a systematic, robust way to find a good solution to a relevant problem in the field of service management and it is very easy to implement using no more than commonly accessible tools.
Ross, S J; Polsky, D; Sochalski, J
The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. To predict the international migration of nurses to the UK using widely available data on country characteristics. The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.
Suzuki, Yoshimi; Saito, Emiko; Sawai, Minako; Kishi, Emiko; Kakemoto, Satori; Nakada, Harumi; Igarashi, Chiyo; Asahara, Kiyomi
Objective To equip public health nurses (PHNs) with higher qualifications, PHN education is shifting from an integrated curriculum for PHNs and registered nurses to a specific elective system of undergraduate or postgraduate programs. Most colleges in the special wards of Tokyo introduced the elective system in 2014 before the remaining areas. The outcomes of this must be evaluated. This study aimed to evaluate the achievement levels and practical experiences of PHN students at seven colleges in the special wards before and after introduction of the PHN course as an elective.Method Self-administered, anonymous questionnaires were completed by senior PHN students at seven colleges in the special wards who underwent training in 2013, the last year of an integrated curriculum, and in 2014, the first year of the elective system. The target numbers of participants were 663 in 2013 and 136 in 2014 with 20 students from each school exposed to the elective system. Our study focused on whether they achieved the 98 "technical items of PHN training and achievement levels at the time of graduation" required by the Ministry of Health, Labour and Welfare. The study also determined whether participants obtained practical experience in 15 items developed by the special wards based on the standards set for training.Results In 2013, there were 348 total responses (52.5%) and 310 valid responses. In 2014, there were 136 total responses (88.2%) and 120 valid responses. The average achievement rate at which the student answered, "I was able to arrive at it," at an arrival degree level for the 98 technical items was 72.6% in 2014, an increase compared to the 67.9% obtained in 2013. Moreover, the average practical experience rate at which the student answered, "I was able to have an experience," regarding the 15 items was 85.7% in 2014, which constituted an increase compared to 70.5% attained in 2013. However, the number of items with an achievement rate of more than 80% remained
Vogel, Todd R.; Petroski, Gregory F.; Kruse, Robin L.
OBJECTIVES: Nursing home residents’ ability to independently function is associated with their quality of life. The impact of amputations on functional status in this population remains unclear. This analysis evaluated the effect of amputations—Transmetatarsal (TMA), Below-knee (BK), and Above-knee (AK)—on residents’ ability to perform self-care activities. METHODS: Medicare inpatient claims were linked with nursing home assessment data to identify admissions for amputation. The MDS ADL-Long form score (0-28; higher indicating greater impairment), based on seven activities of daily living, was calculated before and after amputation. Hierarchical modeling determined the effect of the surgery on residents’ post-amputation function. Controlling for comorbidity, cognition, and pre-hospital function allowed for evaluation of activities of daily living (ADL) trajectories over time. RESULTS: 4965 residents underwent amputation: 490 TMA, 1596 BK and 2879 AK. Mean age was 81 and 54% of the patients were women. Most were White (67%) or African-American (26.5%). Comorbidities prior to amputation included diabetes (DM, 70.7%), coronary heart disease (57.1%), chronic kidney disease (53.6%), and/or congestive heart failure (CHF, 52.1%). Mortality within 30 days of hospital discharge was 9.0% and hospital readmission was 27.7%. Stroke, end-stage renal disease (ESRD), and poor baseline cognitive function were associated with the poorest functional outcome after amputation. Compared with residents who received TMA, those who had BK or AK recovered more slowly and failed to return to baseline function by six months. BK was found to have a superior functional trajectory compared with AK. CONCLUSIONS: Elderly nursing home residents undergoing BK or AK amputation failed to return to their functional baseline within six month. Among frail elderly nursing home residents, higher amputation level, stroke, ESRD, poor baseline cognitive scores, and female gender were associated
Blackman, Ian; de Crespigny, Charlotte; Parker, Steve
This study seeks to identify factors that influence the perceived complexity of providing nursing care to others (who are dependent on alcohol and tobacco) and the confidence of undergraduate student nurses to carry out this care. The research project is designed to explore whether there is a difference between the perceived complexities of 57…
Holden, Richard J; Scanlon, Matthew C; Patel, Neal R; Kaushal, Rainu; Escoto, Kamisha Hamilton; Brown, Roger L; Alper, Samuel J; Arnold, Judi M; Shalaby, Theresa M; Murkowski, Kathleen; Karsh, Ben-Tzion
Nursing workload is increasingly thought to contribute to both nurses' quality of working life and quality/safety of care. Prior studies lack a coherent model for conceptualising and measuring the effects of workload in healthcare. In contrast, we conceptualised a human factors model for workload specifying workload at three distinct levels of analysis and having multiple nurse and patient outcomes. To test this model, we analysed results from a cross-sectional survey of a volunteer sample of nurses in six units of two academic tertiary care paediatric hospitals. Workload measures were generally correlated with outcomes of interest. A multivariate structural model revealed that: the unit-level measure of staffing adequacy was significantly related to job dissatisfaction (path loading=0.31) and burnout (path loading=0.45); the task-level measure of mental workload related to interruptions, divided attention, and being rushed was associated with burnout (path loading=0.25) and medication error likelihood (path loading=1.04). Job-level workload was not uniquely and significantly associated with any outcomes. The human factors engineering model of nursing workload was supported by data from two paediatric hospitals. The findings provided a novel insight into specific ways that different types of workload could affect nurse and patient outcomes. These findings suggest further research and yield a number of human factors design suggestions.
Nakatani, Junko; Hara, Yoshiko; Ikeda, Tomoko; Ishihara, Itsuko
The purpose of this study was to evaluate the program and teaching methods of the occupational health nursing practicum in order to enforce students' learning experience in the clinical practice. Self-evaluation sheets graded from levels 1 to 4 were from 63 students, and statistical analysis was performed in relation to their performance levels. The results of the analysis of 63 students' performance sheets indicated that the students achieved 3 points above average in all 14 course objectives. Scales analysis of the students' evaluation sheets also revealed that students' achievement levels were lower at the Industrial Health Organization in comparison with those at the industrial enterprises. To make students' practice more valuable, students' assessment skills of the workers and working environment should be emphasized in the classroom teaching and experience of learning at the laboratory. Moreover, the course objectives should be sufficiently linked to the practice areas in order to differentiate between the features of the Health organizations and enterprises.
Hansen, Åse Marie; Helene Garde, Anne; Hansen, Johnni
samples were collected during 24 h from the participants on a work day and on a day off and were analyzed for 6-sulphatoxymelatonin. On the day of urine sampling, participants filled in the Karolinska Sleep Diary. Additional information was collected through a telephone interview. Data were analyzed using...... differences were observed between a workday and a day off when doing day and evening shifts, irrespective of mixed and fixed schedules. Sleep length was reduced workdays (from 6.1-6.8 h) among all nurses, compared to days off (from 7.8-8.7 h)....
Sabancıogullari, Selma; Dogan, Selma
The aim of this study was to evaluate the effects of the Professional Identity Development Program on the professional identity, job satisfaction and burnout levels of registered nurses. This study was conducted as a quasi-experimental one with 63 nurses working in a university hospital. Data were gathered using the Personal Information Questionnaire, the Professional Self Concept Inventory, Minnesota Job Satisfaction Inventory and the Maslach Burnout Inventory. The Professional Identity Development Program which consists of ten sessions was implemented to the study group once a week. The Program significantly improved the professional identity of the nurses in the study group compared to that of the control group. During the research period, burnout levels significantly decreased in the study group while those of the control group increased. The programme did not create any significant differences in the job satisfaction levels of the nurses. The programme had a positive impact on the professional identity of the nurses. It is recommended that the programme should be implemented in different hospitals with different samples of nurses, and that its effectiveness should be evaluated.
Zhang, Yuxia; Liu, Linxia; Hu, Jing; Zhang, Yanhong; Lu, Guoping; Li, Guangyu; Zuo, Zelan; Lu, Hua; Zou, Huan; Wang, Zaihua; Huang, Quelan
Nursing-sensitive indicators are considered effective tools for improving the quality of care in hospitals. However, these have not been used in paediatric intensive care units (PICUs) in China. To develop nursing-sensitive indicators for PICUs and to assess the quality of nursing in PICUs in China based on the nursing-sensitive indicators. Multi-centre, cross-sectional study. Structure, process and outcome indicators were developed and measured from 1 January to 31 March 2014 in seven PICUs in China. The structure indicators showed that one nurse cared for an average of 2·8 patients in a PICU, and 44% of nurses had a bachelor's degree. The process indicators revealed that hand-washing compliance varied across PICUs, whereas pain management and physical restraint have not been adequately addressed in China. The outcome indicators revealed that the incidence rates of ventilator-associated pneumonia and central-line-associated blood stream infections were 2·96 and 0·7, respectively, per 1000 device days. Patients were intubated for a total of 4392 mechanical ventilator days, and 32 patients (7·29‰) had an unplanned extubation. Nurses were moderately satisfied in their jobs (3·1 ± 0·3), and parents reported that nurses provide high quality of care. This study developed and used nursing-sensitive indicators to assess the quality of nursing in PICUs in China, which provided a reference for national and international comparisons of nursing quality in PICUs. Nursing staffing levels and education should be improved. Pain management and physical restraints should be regulated in China's PICUs. Nurse managers need to explore staff attitudes towards implementation of family-centred care. The development of a national database of nursing quality indicators can contribute to quality and safety improvement. This study developed a set of nursing-sensitive indicators, and these indicators were used to assess and improve the quality of nursing in PICUs. © 2016 British
Agus Arianto Toly
Full Text Available The high level of turnover intentions by accountant staffs had raised the potential cost for public accountant firms. The prior research done by Suwandi and Indriantoro (1999 had succesfully identified the process of turnover intentions, which related to the antecedents and consequences of job insecurity. The responses of 30 accountant staffs from some public accountant firms to a questionnaire designed to measure variables were analyzed using a Pearson's correlation coefficient. The result of this study was not generally consistent with Suwandi and Indriantoro (1999 because some hypotheses were rejected. This study identified that public accountant firm must be noticed organizational factors, such as organizational commitment, role conflict, role ambiguity, and organizational change. Abstract in Bahasa Indonesia : Tingkat keinginan berpindah yang tinggi para staf akuntan telah menimbulkan biaya potensial untuk Kantor Akuntan Publik (KAP. Penelitian sebelumnya yang dilakukan oleh Suwandi dan Indriantoro (1999 telah berhasil mengidentifikasi proses keinginan berpindah, yang berhubungan dengan anteseden dan konsekuensi dari ketidakamanan kerja. Respon 30 staf akuntan dari beberapa KAP terhadap kuesioner yang dibuat untuk mengukur berbagai variabel, dianalisis menggunakan kofisien korelasi Pearson. Hasil dari studi ini secara umum tidak konsisten dengan Suwandi dan Indriantoro (1999 karena ditolaknya beberapa hipotesis. Studi ini mengidentifikasi bahwa KAP harus memberi perhatian terhadap beberapa faktor organisasional, seperti komitmen organisasional, konflik peran, ketidakjelasan peran, dan perubahan organisasional. Kata kunci: konflik peran; ketidakjelasan peran; perubahan organisasional; ketidakamanan kerja; komitmen organisasional; keinginan berpindah.
目的：分析与探讨护理组长层级管理在骨科护理中的应用效果，为医院管理层提供管理理论上的支持。方法采用APN连续排班方式，实行护士长-护理组长-责任护士-助理护士的层级管理模式，比较、分析护理组长责任制模式下所负责病区的综合护理质量、护理人员业务能力、护理人员专业知识以及医患满意度。结果实行护理组长层级管理制度后，第一，护理人员的理论知识水平和实践操作能力都有了很大的提升，前为（73.2±4.3)和（83.7±4.8)；后为（89.2±3.9)和（92.5±5.4)。第一，医生和患者对护理的满意度均有明显提升，前为（86.9±2.9)和（68.2±7.1)；后为（93.9±5.1)和（89.9±6.7)。差异有统计学意义（P<0.05)。结论护理组长层级管理的实施，有效发挥出护理组长在整个护理工作的核心作用，通过自身的专业技能，有效促进了护理人力资源的科学配置，提升了骨科护理的综合质量与医患满意度，有利于医院的规范化管理与发展。%Objective Analysis and Discussion nursing leader level management application results in orthopedic care, and provide management support for the hospital management theory. Methods APN continuous shifts, the implementation of nurse-nursing leader-the responsibility of nurses - nurses help level management mode, compared and analyzed under nursing leader Responsibility mode quality comprehensive care ward, the nurses in charge of operational capacity, nursing expertise and the doctor-patient satisfaction. Results The nursing team leader level management system, first, the nurses' theoretical knowledge and practical skills have a lot of ascension, for (73.2±4.3) before and (83.7±4.8); For (89.2±3.9) and after (92.5±5.4). First, the doctors and patients to nursing satisfaction were improved significantly, the former (86.9±2.9) and (68.2±7.1);After (93.9±5.1) and (89.9±6.7), the difference
尤黎明; 刘佳丽; 郑晶; 刘可
The important role of nursing work environment has received much attention in the management of nursing workforce and the quality of health care services. This paper analyzed current studies on nursing work environment, and suggested that the government and hospital administrators pay more attention to the development of nursing workforce, adequate clinical nurse staffing levels and promoting healthy work environment for nurses.%护理工作环境在护士队伍建设和护理服务质量管理中的重要地位在近年来受到广泛关注。本文分析了国内外护理工作环境的研究结果及国外护理工作环境的改革策略，建议我国各级卫生行政部门和医疗卫生机构重视护理人才队伍建设，切实保障临床护理人力配置，共同努力构建健康的护理工作环境。
Arnold, Jean M.; Bauer, Carol A.
A questionnaire was used to survey the computer literacy needs of 445 nurse educators and nurse managers within a northeastern metropolitan area. There are commonalities and differences between nurse educators and nurse managers regarding advanced computer applications; but both groups expressed an urgent need for continuing nursing education courses at the advanced level.
Ducatman, A M; Forman, S; Teichman, R; Gleason, R
Increased provision of occupational health services outside the workplace has been accompanied by signs of change in the quantity and structure of in-house corporate services. The occupational physician:employee ratios of the 25 largest US corporations were compared with each other, with the probable level of hazard as suggested by Bureau of Labor Statistics reports, and with both gross and per-capita measures of profitability. We infer that large corporations still employ a disproportionate share of available occupational health expertise. Oil and chemical companies employ the largest number of occupational physicians per capita; computer, electronics, and scientific equipment manufacturers employ the largest number of occupational physicians per capita relative to occupational illness/injury/lost workdays per capita. Tobacco companies employ the fewest occupational physicians by either measure. Corporate profitability explained more than half the variability for the one large within-sector comparison and appeared most related to employment practices for the most-successful and least-successful companies.
张丽凤; 卢孟密; 李春坚; 韦义萍; 廖海涛
目的 了解不同教育层次护士学生(以下简称护生)对社区护理的认知及就业意愿,为促进高校社区护理教育改革,发展社区护理提供依据.方法 采用自行设计的调查问卷对821名不同教育层次护生进行调查.结果 不同教育层次护生对社区护理工作的主观认识及社区护理的就业意愿比较,差异具有统计学意义(均P＜0.01).影响护生选择社区护理作为就业意向的因素有个人因素、专业因素和社会因素.已学习《社区护理学》课程的护生较未学习的护生对社区护理知识的认知得分高.结论 在校护生对社区护理知识整体认知不足,就业于社区的意愿不高.学校应加强指导,改善社区护理实践环境,并适当开展职业指导以培养护生正确的择业观.%Objective To investigate the community nursing knowledge of nursing students in different education levels and their employment intentions so as to promote the university community nursing education reform and provide the basis for the development of community nursing. Method A total of 821 nursing students were surveyed by a self-made questionnaire. Results Among the nursing students in different education levels, there were significant differences in the subjective understanding of the community nursing and their employment intentions (all P < 0.01). The factors influencing nursing students' intentions to choose community nursing as their career included personal, professional and social factors. There were significant differences in the recognition of community nursing knowledge between those having learned the course of Community Nursing and those not having learned it (P < 0.05), but both scored lower. Conclusions The nursing students are lack of recognition of community nursing knowledge and their intentions to work at the communities are not powerful. The schools should strengthen theoretical teaching, improve community nursing practice environment, carry
Hills, Laura Sachs
It's first thing in the morning, the day's appointment schedule is jam-packed, and you just found out that you're going to be short-staffed. After the initial panic wears off what are you and your co-workers going to do? How will you manage to work through your day with fewer people on hand? This article suggests a three-pronged approach to the challenge of medical practice short-staffing. It offers practical tips for avoiding short-staffed days by creating firm policies for staff absences, tardiness, and vacations. This article also describes how cross-training employees, working with temporary employees, and other preparation will make short-staffed days more manageable. Finally, this article provides 10 practical tips for coping with the short-staffed day. It offers helpful advice to any medical practice employee who finds himself or herself feeling overwhelmed by a short-staffed day.
Murray, Melanie; Sundin, Deborah; Cope, Vicki
To explore the connection between+6 nursing leadership and enhanced patient safety. Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation program and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture toward safer practices. The position of this paper is to explore the need to form a nexus between safety culture and leadership for the provision of safe care. Safety is crucial in healthcare for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Andresen, Mette; Frändin, Kerstin; Bergland, Astrid;
Background: Nursing home residents are extremely inactive and deterioration in health and an increasing dependence in activities of daily living (ADL) are common. Physical activity and exercise play a major role in the preservation of physical function and quality of life late in life. However......, evidence for the benefit of rehabilitation in nursing home residents is conflicting and inconclusive. Objective: To evaluate the effect of an individually tailored intervention program of 3 months, for nursing home residents, on ADL, balance, physical activity level, mobility and muscle strength. Methods......: In this single-blind randomized clinical trial with parallel groups, nursing home residents 1 64 years of age from three Nordic countries were included. The intervention group (IG) was assigned to individually tailored physical and daily activities, while the control group (CG) received ordinary care. Primary...
O'Brien-Pallas, Linda; Hayes, Laureen
This paper draws upon empirical research and other published sources to discuss nursing workforce issues, the challenges of using health human resource research in policy decisions and the importance of evidence-based policies and practices for nursing care and outcomes. Increasing evidence points to the critical relationship between registered nurse care and improved patient outcomes. The negative impact that insufficient nurse staffing has on patient, nursing and system outcomes has influenced health human resource researchers to further examine nurses' work environments to determine factors that are amenable to policy change. Survey of literature was conducted. Electronic databases were searched using keywords. Sustained health human resource planning efforts by policy makers are difficult given changing governments and political agendas. The health human resource conceptual framework provides researchers and planners with a guide to decision-making that considers current circumstances as well as those factors that need to be accounted for in predicting future requirements. However, effective use of research depends on communication of findings between researchers and policymakers. Health care managers and other decision-makers in health care organisations often lack an understanding of the research process and do not always have easy access to current evidence. Also, managerial decisions are often constrained by organisational requirements such as resource availability and policies and procedures. Unless nursing workplace issues are addressed, the physiological and psychological stress in the work environments of nurses will continue. Effective health human resource policy and planning (at the macro level) and management strategies (at the micro level) would stabilise the nursing workforce and reduce job stress. Furthermore, the efficiency and cost-effectiveness of the health system could be enhanced through improved health outcomes of care providers and health
Yokoyama, Mami; Suzuki, Miho; Takai, Yukari; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yamamoto-Mitani, Noriko
To explore the association between workplace bullying and workplace environment factors among nurses in Japan. Workplace bullying among nurses is increasing globally and occurs more frequently than among other professions. However, there is little information on the impact of workplace environment factors on nurse bullying in Japan. A cross-sectional survey using a self-administered questionnaire. Participants were 1152 nurses recruited at seminars or training courses outside of their workplaces in Tokyo. Workplace bullying was measured using the Negative Acts Questionnaire-Revised. Participants were considered to have been 'bullied' if they reported experiencing at least one negative act on a daily or weekly basis. Workplace environment factors were measured using the Practice Environment Scale of the Nursing Work Index, which comprises five domains: nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership and support of nurses; staffing and resource adequacy; and collegial nurse-physician relationships. A total of 898 (78·0%) questionnaires were returned, of which 825 (71·6%) were analysed. Altogether, 153 (18·5%) nurses were considered 'bullied.' The three most frequent negative acts reported as occurring on a weekly or daily basis were 'someone withholding information which affects your performance' (6·7%), 'being exposed to an unmanageable workload' (4·4%) and 'being shouted at or being the target of spontaneous anger (or rage)' (3·6%). Logistic regression analysis indicated that 'bullied' were associated with low scores on two work environment domains: nurse manager ability, leadership and support of nurses and staffing and resource adequacy. Effective nurse manager leadership and support as well as appropriate staffing management may positively influence workplace bullying among nurses in Japan. Authentic leadership styles and allowing nurses to easily request days off might also be important
Mohammed, Salisu Ishaku; Ahonsi, Babatunde; Oginni, Ayodeji Babatunde; Tukur, Jamilu; Adoyi, Gloria
Objective: To assess the knowledge of nurse-midwife educators on the major causes of maternal mortality in Nigeria. Setting: Schools of nursing and midwifery in Nigeria. Method: A total of 292 educators from 171 schools of nursing and midwifery in Nigeria were surveyed for their knowledge of the major causes of maternal mortality as a prelude to…
Austin, Joan K.; Kakacek, Jody R. M.; Carr, Deborah
This article presents a quantitative assessment of the impact of an epilepsy-focused training program on school nurses. The Epilepsy Foundation and the National Association of School Nurses (NASN) created a training program titled "Managing Students with Seizures" to educate school nurses on strategies and resources that they can use to handle…
Austin, Joan K.; Kakacek, Jody R. M.; Carr, Deborah
This article presents a quantitative assessment of the impact of an epilepsy-focused training program on school nurses. The Epilepsy Foundation and the National Association of School Nurses (NASN) created a training program titled "Managing Students with Seizures" to educate school nurses on strategies and resources that they can use to handle…
Sermeus, Walter; Aiken, Linda H; Van den Heede, Koen; Rafferty, Anne Marie; Griffiths, Peter; Moreno-Casbas, Maria Teresa; Busse, Reinhard; Lindqvist, Rikard; Scott, Anne P; Bruyneel, Luk; Brzostek, Tomasz; Kinnunen, Juha; Schubert, Maria; Schoonhoven, Lisette; Zikos, Dimitrios
Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the
Abstract Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods\\/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of
Full Text Available Abstract Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data. All staff nurses of a random selection of medical and surgical units (at least 2 per hospital were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate
Background Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. Methods/Design A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences. This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing
Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M
We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance.
Faul, Mark; Sasser, Scott M.; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David
Introduction The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I–IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need”) as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or
Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the
李美仙; 窦娟花; 李宁
Objective To investigate the level and influencing factors of anxiety among nursing students before the nurse qualification test.Method Totally 1527 nursing students in Xi'an were investigated with the Sarason Test Anxiety Scale (TAS) two weeks before the qualification test.Results The total TAS score of nursing students was (19.45±6.24).About 44.83％ of the diploma students,46.80％ of the associate students and 27.59％ of the undergraduate students showed high level of anxiety.The factors influencing the anxiety of nursing students were concerning about their future,confidence,uncomfortable reaction before the test,level of attention that schools pay on this test,professional attitudes,clinic practice or not,personalities and opinions about reform in the test.Conclusion The anxiety of nursing students with different educational backgrounds before the nurse qualification test was at a moderate level.Schools can provide psychological counseling before the exam,if necessary,to mitigate the anxiety level of the nursing students.%目的 调查护生护士资格考试前焦虑程度及影响因素.方法 抽取西安市1527名护生,采用Sarason考试焦虑量表在考试前2周进行调查.结果 护生考试焦虑量表总分为(19.45±6.24)分,分别有44.83％、46.80％、27.59％的中专、大专和高职、本科护生存在高度焦虑.担心前途、自信心、考试前不适反应、学校重视程度、对护理专业的态度、是否继续临床实习、性格及对考试改革的看法是护生考试前焦虑状况的影响因素.结论 不同层次护生护士资格考试前处于中等焦虑水平,学校可开设心理咨询,必要时进行考前心理辅导,降低护生的焦虑水平.
Cooley, Mary Clodagh
Internationally nurses' motivations for post-registration education and the effects of studying are important concerns for the profession. This paper describes Irish nurses' motivations for studying post-registration nursing programmes and the effects of studying on their personal and work lives. Eighteen nurses participated in this qualitative study. Data were collected using three focus groups and a one-to-one interview. Data were analysed using the qualitative data analysis method Framework [Ritchie, J., Spencer, L., 1994. Qualitative data analysis for applied policy research. In: Bryman, A., Burgess, R. (Eds.), Analyzing Qualitative Data. Routledge, London, pp. 173-194]. Three themes were identified: "I want to keep up and I want to keep in there," "It's about juggling and getting the balance" and "I'm looking at things differently." Findings revealed that nurses studied to aid their professional development. Contextual factors influenced their motivations including a free fees initiative and Irish nursing developing into an all graduate profession. The impact of studying on their personal and work lives was broader in scope than their motivations.
Gamroth, Lucia; Budgen, Claire; Lougheed, Mary
new graduates and to retain existing nurses. Stakeholder groups were administrators, labour organizations, professional associations, educators and government. One idea to support job readiness and retention focussed on the feasibility of implementing cooperative education for nursing students. The effort was unsuccessful owing to lack of funding, but resulted in a review of the literature on cooperative education and other work-study programs. Cooperative education connects classroom learning with paid work experience for the purpose of enhancing students' education (Fitt and Heverly 1990; Heinemann and De Falco 1992; Ryder 1987). Reported benefits for students were improved job preparation and graduate retention (Ishida et al. 1998), additional staffing and reduction in orientation time (Cusack 1990; Ishida et al. 1998), increased practice judgment (Cusack 1990; Siedenberg 1989) and better workload management (Ross and Marriner 1985). A work-study model reported in the literature offered benefits similar to those of cooperative education, with greater flexibility in design. An example was the University of Texas Health Science Center at Houston's collaborative work-study scholarship program with local hospitals (Kee and Ryser 2001). Students in second clinical semesters were employed as unlicensed personnel by hospitals. The students, as unlicensed personnel, worked to the level of their nursing preparation. Reported benefits for students were academic credit, financial assistance, interaction with multidisciplinary teams, opportunity to refine clinical skills, understanding of nurses' roles and guaranteed interview for positions on graduation (Kee and Ryser 2001). Benefits for practice organizations were skilled help, the opportunity to recruit new nurses and increased interaction with a university nursing program. While nurse education stakeholders in British Columbia were exploring options, the concept of undergraduate student nurse employment was initiated by a
Gray-Toft, Pamela; Anderson, James G.
Investigated sources of stress experienced by hospice nurses. Stress sources included: physical characteristics of the unit as well as staffing policies designed to improve the quality of care; procedures followed in admitting patients; policies related to the preparation of meals and open visitation; and greater involvement with the patient and…
Burmen, B; Owuor, N; Mitei, P
An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. Our assessment revealed a severe shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs.
STIFTER, Janet; YAO, Yingwei; LOPEZ, Karen Dunn; KHOKHAR, Ashfaq; WILKIE, Diana J.; KEENAN, Gail M.
The influence of the staffing variable nurse continuity on patient outcomes has been rarely studied and with inconclusive results. Multiple definitions and an absence of systematic methods for measuring the influence of continuity have resulted in its exclusion from nurse-staffing studies and conceptual models. We present a new conceptual model and an innovative use of health information technology to measure nurse continuity and to demonstrate the potential for bringing the results of big data science back to the bedside. Understanding the power of big data to address critical clinical issues may foster a new direction for nursing administration theory development. PMID:26244480
Stifter, Janet; Yao, Yingwei; Lopez, Karen Dunn; Khokhar, Ashfaq; Wilkie, Diana J; Keenan, Gail M
The influence of the staffing variable relational nurse continuity on patient outcomes has been rarely studied and with inconclusive results. Multiple definitions and an absence of systematic methods for measuring the influence of continuity have resulted in its exclusion from nurse-staffing studies and conceptual models. We present a new conceptual model and an innovative use of health information technology to measure relational nurse continuity and to demonstrate the potential for bringing the results of big data science back to the bedside. Understanding the power of big data to address critical clinical issues may foster a new direction for nursing administration theory development.
Ducharme, Maria P; Bernhardt, Jean M; Padula, Cynthia A; Adams, Jeffrey M
The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice. There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making. A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated. Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC. Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.
... a diploma from an approved nursing program. Registered nurses also must be licensed. Education In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and ...
陈小玲; 陈倪; 余妙冲
Objective To explore the effect of doctor-nurse integration in improve nursing level and quality in neonatal department.Methods We implemented doctor-nurse integration joint ward rounds from January 2015 to December 2015,compared with doctors and nurses separate ward rounds from January 2014 to December 2014.120 nurses of same qualification were randomly selected as observation group (doctornurse integration joint ward rounds) and control group (doctors and nurses separate ward rounds).Compared the qualification rate of professional skills and knowledge,the accuracy rate of nursing assessment,the awareness rate of patients' condition,doctors' satisfaction degree,and the incidence of complications during nursing process of two groups of nurses.Results The qualification rate of professional skills and knowledge,the accuracy rate of nursing assessment,the awareness rate of patients' condition,doctors' satisfaction degree of observation group were higher than those of control group,the incidence of complications during nursing process was lower,with statistically significant differences (P＜0.05).Conclusion Doctor-nurse integration has encouraging effect on nursing level and quality in neonatal department.%目的 探讨医护一体化对提高新生儿科护士专科护理水平及护理质量的影响.方法 2015年1月至2015年12月实施医护一体化联合查房,与2014年1月至2014年12月医护分开查房相对比,随机选取120位同等资质护士作为对照组和观察组,观察组为实施医护一体化查房时期护士组,对照组为未实施医护一体化查房时期护士组,观察比较两组护士专科知识合格率、护理评估准确率、病情知晓率、医生对护士满意度、护理并发症发生率.结果 观察组护士的专科知识合格率、护理评估准确率、病情知晓率高于对照组,护理并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 医护一体化对提高新生儿专科护理水平及质量具有促进作用.
A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study.
Luckett, Tim; Chenoweth, Lynnette; Phillips, Jane; Brooks, Deborah; Cook, Janet; Mitchell, Geoffrey; Pond, Dimity; Davidson, Patricia M; Beattie, Elizabeth; Luscombe, Georgina; Goodall, Stephen; Fischer, Thomas; Agar, Meera
Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.
Drennan, Jonathan; Naughton, Corina; Allen, Deirdre; Hyde, Abbey; O'Boyle, Kathy; Felle, Patrick; Treacy, Margaret Pearl; Butler, Michelle
Prescriptive authority for nurses and midwives was introduced in Ireland in 2007. This allows nurses and midwives who have completed a prescribing preparation programme to independently prescribe a wide-range of medications. To date little is known of patient outcomes such as satisfaction with the consultation process and intention to comply as a consequence of the introduction of nurse and midwife prescribing. There are four principal objectives within this study: (1) to measure the level of patients' satisfaction with education and advice received from a nurse or midwife with a prescribing remit; (2) to measure patients' satisfaction with the consultation process; (3) to measure patients' self-reports of their intention to comply with the prescriber's prescription and advice; and (4) to identify the variables that predict patients' intention to comply with the prescription and advice provided by a nurse or midwife with prescriptive authority. Cross-sectional descriptive survey. A total of one hundred and forty respondents completed the survey. Respondents consisted of adult patients who had received a prescription from a nurse prescriber in a general hospital, women who had received a prescription from a midwife in a maternity hospital and parents whose child received a prescription from a nurse in a children's hospital. Instruments used to measure patient outcomes included the Consultation Satisfaction Questionnaire (CSQ) and the compliance intent subscale of the Medical Interview Satisfaction Scale (MISS). A linear multiple regression model was performed to identify the variables that predicted patients' intent to comply. Patients and parents surveyed were highly satisfied with the care they received from nurses and midwives with prescriptive authority. Respondents also reported that they received comprehensive education and advice. Predictors of compliance intent included patient satisfaction with the time spent with the nurse or midwife during the prescribing
向家艮; 刘可; 尤黎明; 张利峰
目的 调查广州市三级甲等综合医院病人安全文化的现状.方法 采用病人安全文化的医院调查问卷,对广州市7所三级甲等综合医院进行病人安全文化测评.结果 病人安全文化正性应答率较高的维度为“组织学习与持续改进”(90.04％)与“科室内团队合作”(87.22％).而有待改进的领域有“人员配置”(24.40％)、“对差错的非惩罚性反应”(32.56％)、“沟通的公开性”(40.47％)以及“事件报告频率”(44.59％).多元回归分析显示,工作年限、是否知晓差错报告系统和对差错报告系统的评价是护士评价病人安全文化的主要影响因素(P＜0.01或P＜0.05).结论 广州市三级甲等综合医院在人员配置、对错误的非惩罚性反应、沟通的公开性等方面有待改进.各医院应加强对差错报告系统的完善,并鼓励更多护士为病人安全管理建言献策.%Objective To investigate nurses'attitude towards patient safety culture in 3 A - level general hospitals in Guangzhou. Methods The Hospital Survey on Patient Safety Culture was adopted to assess patient safety culture in seven 3A - level general hospitals in Guangzhou. Results The positive response rate(PRR) in teamwork within units and organizational learning - continuous improvement were 87. 22% and 90.04% ,respectively. There were some areas with room for improvement, including staffing ( PRR =24.40% ) ,non -punitive response to errors ( PRR =32. 56% ) .communication openness ( PRR =40.47% ) and frequency of events reported (PRR =44.59% ). Multiple regression analysis revealed that the work experience,whether knew event report system and the e-valuation of error reporting system were the main influence factors for nurses's attitude towards patient safety culture (P ＜ 0.01 or P ＜ 0.05). Conclusion Improvement should be made in staffing,non - punitive response to errors and communication openness in 3A - level general hospitals in Guangzhou
Rice, Megan S; Tworoger, Shelley S; Bertrand, Kimberly A; Hankinson, Susan E; Rosner, Bernard A; Feeney, Yvonne B; Clevenger, Charles V; Tamimi, Rulla M
Higher circulating prolactin levels have been associated with higher percent mammographic density among postmenopausal women in some, but not all studies. However, few studies have examined associations with dense area and non-dense breast area breast or considered associations with prolactin Nb2 lymphoma cell bioassay levels. We conducted a cross-sectional study among 1,124 premenopausal and 890 postmenopausal women who were controls in breast cancer case-control studies nested in the Nurses' Health Study (NHS) and NHSII. Participants provided blood samples in 1989-1990 (NHS) or 1996-1999 (NHSII) and mammograms were obtained from around the time of blood draw. Multivariable linear models were used to assess the associations between prolactin levels (measured by immunoassay or bioassay) with percent density, dense area, and non-dense area. Among 1,124 premenopausal women, percent density, dense area, and non-dense area were not associated with prolactin immunoassay levels in multivariable models (p trends = 0.10, 0.18, and 0.69, respectively). Among 890 postmenopausal women, those with prolactin immunoassay levels in the highest versus lowest quartile had modestly, though significantly, higher percent density (difference = 3.01 percentage points, 95 % CI 0.22, 5.80) as well as lower non-dense area (p trend = 0.02). Among women with both immunoassay and bioassay levels, there were no consistent differences in the associations with percent density between bioassay and immunoassay levels. Postmenopausal women with prolactin immunoassay levels in the highest quartile had significantly higher percent density as well as lower non-dense area compared to those in the lowest quartile. Future studies should examine the underlying biologic mechanisms, particularly for non-dense area.
Andressa Magalhães Teixeira
Full Text Available ABSTRACT Objective: to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method: an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results: altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions: risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.
张宝莲; 周彩峰; 王玲
目的:通过对NICU护士进行分层次使用管理,合理利用现有的人力资源,激发护理人员的工作热情、提高护士工作满意度.方法:根据护理人员的职称,学历.工作年限,个人实际工作能力等进行综合评价,将护士优化组合分层次使用后,用Mudler/McCloskey满意度量表(MMSs)对NICU护士进行问卷调查.结果:护士的工作满意度明显提高,既稳定了护理队伍,减少了人员流失,又保证了护理质量.结论:分层次使用可提高护士的工作满意度,调动护理人员的工作积极性,提高工作效率,合理使用现有人力资源,达到人尽其才,才尽其用的目的.%Objective: To rationally utilize existing human resource, explode nurses' job enthusiasm and improve job satisfaction through using nurses at different levels in the NICU. Methods: Nurses were evaluated according to rank, educational level working life and personal working capability and then they were used at different levels. After that,Mudler/McCloskey(MMSs) job satisfaction questionnaires were completed by them.Results: The score of job satisfaction markedly improved. Conclusion: Using nurses at different levels could increase nurses' job satisfaction, mobilize nurses' job enthusiasm,enhance work efficiency and rationally utilize existing human resource.
Trautmann, Jennifer; Epstein, Elizabeth; Rovnyak, Virginia; Snyder, Audrey
The aims of this research study were to investigate moral distress among emergency department (ED) nurse practitioners (NPs) and examine relationships between moral distress and level of practice independence as well as intent to leave a position. Moral distress has been studied regarding registered nurses and physicians (MDs) but less so in NPs. It is important to explore moral distress in NPs because they tread a unique path between nursing and physician roles. Moral distress may play a significant role in staff nurses' intention to leave practice, and level of practice independence is found to have a relationship with NPs' intention to leave. A convenience sample of ED NPs was obtained from a mailing list of a national nursing specialty organization, the Emergency Nurses Association. Using a correlational design, survey methods assessed moral distress with the Moral Distress Scale-Revised (MDS-R), level of practice independence with the Dempster Practice Behavior Scale, and intent to leave with self-report. Correlational and regression analyses of data were conducted to characterize moral distress among ED NPs and associations between moral distress, level of practice independence, and intent to leave. Results found ED NPs do experience moral distress with poor patient care results from inadequate staff communication and working with incompetent coworkers in their practice. The MDS-R was a significant predictor of intention to leave among respondents. This study is the first of its kind to explore moral distress in ED NPs. Results suggest moral distress influences ED NPs' intent to leave their position. Further studies are needed to explore the findings from this research and to formulate interventions to alleviate moral distress in ED NPs and improve retention in the clinical setting.
Full Text Available The paper developed a model of staffing formation in the organization. Author analyzed the gender, age and education staff characteristics, work experience, job categories, staff training, staff movement and enrollment personnel reserve in the State Statistics Service of Ukraine. This study provides the measures to implement a plan of staffing formation in the State Statistics Service of Ukraine.
The paper developed a model of staffing formation in the organization. Author analyzed the gender, age and education staff characteristics, work experience, job categories, staff training, staff movement and enrollment personnel reserve in the State Statistics Service of Ukraine. This study provides the measures to implement a plan of staffing formation in the State Statistics Service of Ukraine.
van der Veen, Egbert; Boucherie, Richardus J.; van Ommeren, Jan C.W.
This paper discusses staffing under annualized hours. Staffing is the selection of the most cost-efficient workforce to cover workforce demand. Annualized hours measure working time per year instead of per week, relaxing the restriction for employees to work the same number of hours every week. To
Creamer, Don G.; Winston, Roger B., Jr.
Performance appraisal is widely endorsed as an essential part of the staffing process, yet most student affairs practitioners acknowledge that it is done poorly, or not at all, in their institutions. The reasons for this neglect are outlined, and suggestions are offered for ways to make performance appraisal a more valuable staffing tool.…
Gray, Linda R; Shirey, Maria R
To describe what nurse manager engagement means to nurse managers and staff nurses by incorporating an organizational dashboard to document engagement outcomes. Retaining engaged nurse managers is crucial for individual performance and organizational outcomes. However, nurse manager engagement is currently underreported in the literature. Existing data from the 2010 Employee Opinion Survey at the Baylor University Medical Center in Dallas, Texas, were used to measure staff engagement among 28 nurse managers and 1497 staff nurses. The data showed a 21% gap between manager and staff nurse engagement levels, with managers showing higher engagement levels than staff. No clear depiction of nurse manager engagement emerged. Consequently, an expanded definition of nurse manager engagement was developed alongside a beginning dashboard of engagement outcomes. The findings have implications for overcoming barriers that affect staff nurse engagement, improving outcomes, and creating definitions of nurse manager engagement.
Full Text Available Kinerja Staff merupakan salah satu kunci dalam kemajuan organisasi, terutama organisasi non laba. Yayasan Dian Mandiri merupakan salah satu lembaga yang mengembangkan usaha mikro melalui penyediaan modal usaha, pelatihan dan pendampingan usaha. Lebih dari 52.000 klien aktif dilayani oleh lebih dari 300 staf. Oleh karenanya memerlukan staf yang mempunyai mempunyai motivasi tinggi untuk mendukung kinerjanya. Pelatihan metode revolusi mental diadakan pada bulan Februari 2016 untuk karyawan tingkat supervisor dan manager di Yayasan Dian Mandiri, agar dapat mengembankan metode transformatif dalam mengembangkan kinerja staf yang dipimpin oleh mereka. Pelatihan ini berlangsung selama satu hari dengan materi tentang pengenalan profil kinerja staf, metode coaching dan coaching transformatif dengan menggubakan model Lewin. Sebelum pelatihan kepada para peserta mengisi pre test yang sudah disiapkan dan diakhir pelatihan mengisi post test. Dari hasil pelatihan ini menunnjukan peningkatan pengetahuan dan ketrampilan peserta dalam mempraktekkan metode coaching transformatif pada diri sendiri, staf dan organisasi untuk mendukung kinerja organisasi
Conclusions: Nurse is required to be able to perform their therapeutic communication skill effectively so that the anxiety level of family members is decreasing. As a result, the stable emotion of family members affect to the appropriate decision making of medical treatment. [Int J Res Med Sci 2016; 4(12.000: 5456-5462
Results: It was found that the average age of students in study was 21.11 +/- 2.16 (min. 18, max 28, 81.1% of students were female, 58.7% of students' mothers and 44.3% of students fathers had primary school graduates, 10.5% of students' families were in not good income status and 55.9% of students were willingly preferred their departments. The total Cronbach alpha reliability scale was calculated as 0.71. The total average scale score of students was determined as 81.83 +/- 21.51. It was found that female students, students who were willingly preferred their departments and students who had mothers with higher education levels had significantly higher scale scores (p0.05. Conclusion: According to the results of the study, it was concluded as the students' self-effectiveness-efficacy levels were above the middle level. It was concluded that the students' self-effectiveness-efficacy levels which were above the middle level have been affected by the variables as their mothers' education levels and their willingly choosing their departments. In order to increase the level of self-effectiveness-efficacy of students, the students must be supported by scholars and their families. Teaching staff may contribute the students' self-effectiveness-efficacy levels by using strategies like to appreciate the positive aspects of students, to separate to pieces the processes and concepts by using concept maps and to follow a path towards from simple to complex. [J Contemp Med 2016; 6(3.000: 206-213
Full Text Available Abstract Background Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses' perceptions and experiences of productivity and human resource factors improving or impeding it. Method A qualitative approach was used to obtain rich data; open, semi-structured interviews were also conducted. The sampling was based on the maximum variant approach; data analysis was carried out by content analysis, with the constant comparative method. Results Participants indicated that human resources issues are the most important factor in promoting or impeding their productivity. They suggested that the factors influencing effectiveness of human resource elements include: systematic evaluation of staff numbers; a sound selection process based on verifiable criteria; provision of an adequate staffing level throughout the year; full involvement of the ward sister in the process of admitting patients; and sound communication within the care team. Paying attention to these factors creates a suitable background for improved productivity and decreases negative impacts of human resource shortages, whereas ignoring or interfering with them would result in lowering of nurses' productivity. Conclusion Participants maintained that satisfactory human resources can improve nurses' productivity and the quality of care they provide; thereby fulfilling the core objective of the health care system.
Alavi, C; Cattoni, J
The construction of the nursing subject is discussed. The paper takes a historical perspective, arguing that the range of speaking positions available to the nurse is limited by gender, class and education. It evaluates the position of nursing in the university, showing how this also has propensity to limit the development of the nursing profession.
Full Text Available Background: Low back pain has been found to be the most prevailing musculoskeletal condition as well as a common cause of absence from workplace. Studies report that low back pain is common and accounts for a large number of reported disabilities among nurses. In fact nursing have one of the highest levels of back injury in all occupation groups. The aim of this study is to determine the prevalence of low back pain among nurses in a public sector teaching hospital of Karachi. This study has mainly focused on confounding factors leading to low back pain and level of education among nurses regarding patients handling or shifting techniques. Methods: A self-administered questionnaires comprises of three sections, were used to collect data. The first section requested for socio-demographic information, followed by medical history of back pain during last month and during last year.The second section assessed the medical history of LBP in two categories i.e. during last month and during last year.The third and last section inquired about participants’ level of education about ergonomics with simply in yes or no pattern.The questionnaires were given to 100 nurses. All questionnaires were completed in the presence of theresearcher. Out of 100 questionnaires distributed and recorded, only 47 participants returned the questionnaire. Results: Statistical Package for the Social Sciences (SPSS version 19.0 was used for statistical analysis. Relationship between the prevalence of low back pain and training in patient moving techniques, manual material handling techniques is significant (p=0.017,p= 0.068. There is a weak relationship with the knowledge of ergonomics, biomechanics and back pain preventive measures (p=0.719,p=0.457,p=0.704. Conclusion: More than two third of the participated nurses were well trained in transfer techniques, manual material training and preventive measures of back pain. But they lack the biomechanical knowledge. The prevalence
陈凤姣; 李继平; 马芳; 方进博; 刘素珍
Objective To investigate the level and influencing factors of nursing competence among junior nurses receiving standardized training,and provide evidence for the training. Method Totally 299 junior nurses receiving standardized training were investigated using the Six-Dimension Scale of Nursing Performance(6-D scale). Results The junior nurses rated higher scores on the dimensions of professional development and interpersonal communication,while lower scores on the dimensions of planning and evaluation and teaching and collaboration. Vocational interest, educational background, satisfaction with income and satisfaction with working atmosphere were influencing factors of their self-rating nursing competence. Conclusion The standardized training should focus on the training of junior nurses' planning, evaluation, teaching and collaboration competence, and take educational background into account. In addition,the administrators should pay attention to junior nurses' vocational interest, create a good working atmosphere and implement reasonable salary allocation.%目的 了解低年资规范化培训护士护理能力现状和影响因素,为培训实践提供依据.方法 利用护理能力六维评价量表(6-D量表)对299名规范化培训护士进行横断面调查.结果 调查对象的专业发展和人际沟通维度得分最高,计划评估和教学协作维度相对较低.职业兴趣、学历、工资收入满意度和工作氛围满意度对护理能力有影响.结论 规范化培训应加强计划评估和教学协作能力的培养,同时应考虑护士的学历,注重培养职业兴趣,创造良好工作氛围,合理进行薪酬分配.
.... Time Staffing, Inc., Personnel Management Group, Inc., Including Workers Whose Unemployment Insurance... workers of Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc...., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc., including workers...
Dingley, Jacquelyn; Yoder, Linda
Public health nurses (PHNs) work to address critical health issues at the individual, family, and population levels. In recent years, a global nursing shortage has posed a significant challenge to the recruitment and retention of PHNs. Hospital-based research has shown that a healthy and productive work environment is vital to successful nursing recruitment and retention. Specific organizational characteristics have been linked to job satisfaction, organizational commitment, job vacancies, and turnover rates. Although it is presumed that similarities exist between the public health and acute care nursing work environments, further evaluation is required. This literature review was conducted to identify studies that characterize the PHN work environment. An online database search was conducted to identify prospective PHN studies published between 2000 and 2010. Definitions were established for screening purposes. Twenty-nine PHN studies in the United States and abroad met criteria for inclusion in this review. Satisfaction with teamwork and job autonomy generally was reported. However, inadequate PHN staffing was described as a concern, with problems magnified during prolonged response to public health emergencies. Insufficient control over PHN practice was reported as well. Perceptions regarding other work environment characteristics were mixed or were not measured in detail. More in-depth research is recommended with the ultimate goal of improving PHN recruitment and retention.
Kitchener, Martin; O'Meara, Janis; Brody, Ab; Lee, Hyang Yuol; Harrington, Charlene
Objective To analyze corporate governance arrangements and quality and financial performance outcomes among large multi-facility nursing home corporations (chains) that pursue stakeholder value (profit maximization) strategies. Study Design To establish a foundation of knowledge about the focal phenomenon and processes, we conducted an historical (1993–2005) case study of one of the largest chains (Sun Helathcare Inc.) that triangulated qualitative and quantitative data sources. Data Sources Two main sets of information were compared: (1) corporate sources including Sun's Security Exchange Commission (SEC) Form 10-K annual reports, industry financial reports, and the business press; and (2) external sources including, legal documents, press reports, and publicly available California facility cost reports and quality data. Principal Findings Shareholder value was pursued at Sun through three inter-linked strategies: (1) rapid growth through debt-financed mergers; (2) labor cost constraint through low nurse staffing levels; and (3) a model of corporate governance that views sanctions for fraud and poor quality as a cost of business. Conclusions Study findings and evidence from other large nursing home chains underscore calls from the Institute of Medicine and other bodies for extended oversight of the corporate governance and performance of large nursing home chains. PMID:18454781
Tanaka, Michiko; Yonemitsu, Yoshikazu; Kawamoto, Rieko
The aim of this study was to quantify the professionalism of nurses in Japan. The Japanese version of the Behavioural Inventory for Professionalism in Nursing was conducted as a national survey. Computer-generated random selection of nurses in Japan obtained responses from 1501 nurses. A descriptive design examined the levels of and differences in nursing professionalism. Comparisons of the total level of professionalism in educational preparation, current position, years of experience, and current practice setting were analysed by one-way analysis of variance and post hoc Tukey-Kramer multiple comparison test. The results revealed that Japanese nurses had low levels of professionalism, and professionalism was related significantly to higher educational preparation, years of experience as a nurse, and current position as a nursing administrator or faculty. The results can be used as a benchmark for continued assessments of the level of nursing professionalism and for further development of nursing professionalism. © 2013 Wiley Publishing Asia Pty Ltd.
Lavin, Mary Ann; Harper, Ellen; Barr, Nancy
The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.
Debora L. Madsen
Full Text Available Institutional repositories (IRs have become established components of many academic libraries. As an IR matures it will face the challenge of how to scale up its operations to increase the amount and types of content archived. These challenges involve staffing, systems, workflows, and promotion. In the past eight years, Kansas State University's IR (K-REx has grown from a platform for student theses, dissertations, and reports to also include faculty works. The initial workforce of a single faculty member was expanded as a part of a library-wide reorganization, resulting in a cross-departmental team that is better able to accommodate the expansion of the IR. The resultant need to define staff responsibilities and develop resources to manage the workflows has led to the innovations described here, which may prove useful to the greater library community as other IRs mature.
Kumar, Sumit; Nandi, Sukumar
Copyright protection has become a need in today's world. To achieve a secure copyright protection we embedded some information in images and videos and that image or video is called copyright protected. The embedded information can't be detected by human eye but some attacks and operations can tamper that information to breach protection. So in order to find a secure technique of copyright protection, we have analyzed image processing techniques i.e. Spatial Domain (Least Significant Bit (LSB)), Transform Domain (Discrete Cosine Transform (DCT)), Discrete Wavelet Transform (DWT) and there are numerous algorithm for watermarking using them. After having a good understanding of the same we have proposed a novel algorithm named as Stage Staffing Algorithm that generates results with high effectiveness, additionally we can use self extracted-watermark technique to increase the security and automate the process of watermark image. The proposed algorithm provides protection in three stages. We have implemented the ...
Edwards, Nadine; Gilbert, Arianna; Mander, Rosemary; McHugh, Nessa; Murphy-Lawless, Jo; Patterson, Jenny
The effects of budgetary changes on midwives' practice environment have raised concerns in many settings. A survey of midwives and student midwives in the UK and Republic of Ireland in 2014 produced 280 responses. Staffing shortages were regarded as underpinning many changes, one of which was that of previously optional 'extra' activities, such as unpaid overtime, becoming mandatory. Shortages were aggravated in less acute areas by the transfer of midwives to more acute settings. One of the fears expressed by midwives was that a permanent change in the culture of midwifery would result. These phenomena are the everyday experiences of practising midwives, but they have failed to be addressed in the documents published by regulatory and review bodies.
Full Text Available Context: There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI. Aims: To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters. Settings and Design: A retrospective medical chart review in a single hospital. Materials and Methods: A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Student′s t-test. Results: A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO 2 , statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%. There were no relationships between an improvement in subjective symptoms and the SpO 2 . Conclusion: Improvements in the subjective symptoms and/or SpO 2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids.
Cassells, Judith M.; And Others
A study compared senior nursing students' perceptions about their baccalaureate nursing education as preparation for a professional nursing career with their feelings six months after graduation and entry in their first position in clinical nursing. (MSE)
Objective To explore the effect of level nursing mode in improveing the nursing quality and occupation burnout of nurses in operation room. Methods 46 nurses from June 2012 to December 2013 were selected as research object,and they were randomly divided into control group (routine nursing mode group) and observation group (level nursing mode group),23 cases in each group.The nuring work quality and occupation burnout of two groups before and after the intervention was compared respsctively. Results There was no significant differences in the nuring work quali-ty and occupation burnout between two groups before the intervention (P>0.05),the nuring work quality excellent and good rate of observation group after the intervention was 100.00%,the rate of no occupation burnout was 95.65%,which was obviously better than that in control group,with statistical difference(P0.05)，干预后观察组护理工作质量优良率为100.00%，无倦怠感率为95.65%，显著优于对照组，差异有统计学意义(P<0.05)。结论层级护理模式能够改善手术室护理人员的综合工作状态，值得临床推广应用。
Neighbors, Marianne; Eldred, Evelyn E.
A study to isolate some of the complex skills that nurses are expected to perform in current practice identified 54 skills and surveyed 167 staff nurses and 53 nurse executives to classify the expected level of performance for a new graduate. Results indicated that educators bear responsibility for learning about technology and incorporating it…
Krull, Ivy; Lundgren, Lena; Beltrame, Clelia
Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.
Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa
In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution. Copyright © 2014 Elsevier Ltd. All rights reserved.
Maenhout, Broos; Vanhoucke, Mario
The efficient and effective management of nursing personnel is of critical importance in a hospital's environment comprising approximately 25 % of the hospital's operational costs. The nurse organizational structure and the organizational processes highly affect the nurses' working conditions and the provided quality of care. In this paper, we investigate the impact of different nurse organization structures and different organizational processes for a real-life situation in a Belgian university hospital. In order to make accurate nurse staffing decisions, the employed solution methodology incorporates shift scheduling characteristics in order to overcome the deficiencies of the many phase-specific methodologies that are proposed in the academic literature.
Kelly, Deena M.; Kutney-Lee, Ann; McHugh, Matthew D.; Sloane, Douglas M.; Aiken, Linda H.
Objectives The mortality rate for mechanically ventilated older adults in ICUs is high. A robust research literature shows a significant association between nurse staffing, nurses’ education, and the quality of nurse work environments and mortality following common surgical procedures. A distinguishing feature of ICUs is greater investment in nursing care. The objective of this study is to determine the extent to which variation in ICU nursing characteristics—staffing, work environment, education, and experience—is associated with mortality, thus potentially illuminating strategies for improving patient outcomes. Design Multistate, cross-sectional study of hospitals linking nurse survey data from 2006 to 2008 with hospital administrative data and Medicare claims data from the same period. Logistic regression models with robust estimation procedures to account for clustering were used to assess the effect of critical care nursing on 30-day mortality before and after adjusting for patient, hospital, and physician characteristics. Setting Three hundred and three adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania. Patients The patient sample included 55,159 older adults on mechanical ventilation admitted to a study hospital. Interventions None. Measurements and Main Results Patients in critical care units with better nurse work environments experienced 11% lower odds of 30-day mortality than those in worse nurse work environments. Additionally, each 10% point increase in the proportion of ICU nurses with a bachelor’s degree in nursing was associated with a 2% reduction in the odds of 30-day mortality, which implies that the odds on patient deaths in hospitals with 75% nurses with a bachelor’s degree in nursing would be 10% lower than in hospitals with 25% nurses with a bachelor’s degree in nursing. Critical care nurse staffing did not vary substantially across hospitals. Staffing and nurse experience were not associated with
Battista, Jerry J; Clark, Brenda G; Patterson, Michael S; Beaulieu, Luc; Sharpe, Michael B; Schreiner, L John; MacPherson, Miller S; Van Dyk, Jacob
The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center-specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per-case staffing ratios were also determined for larger-scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center-specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full-time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively.
Downer, Frances; Shepherd, Chew Kim
Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi's seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.
Full Text Available Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high psychological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses’ health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care. Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress .The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers. Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour’s workshop, all subjects were pre and post tested (one month later for job stress and communication skills with the Karasek’s Job Content Questionnaire (JCQ and communication skills test. Results: Results revealed the following: (1 subjects in both groups after pretest were the middle level of stress and communication skills. (2 After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3 After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks. Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel
目的：分析护理组长在实施护理层级管理制度中的作用。方法选取该院护理人员60名，分为研究组和对照组，各30名，研究组实施的护士长-护理组长-责任护士-辅助护士的管理模式进行管理，对照组实施的护士长-护理人员的管理模式进行管理，观察两组护理人员专业知识实际运用情况，对相应的操作技能进行考核，比较两组的考核成绩和患者的满意度。结果研究组护理人员专业知识掌握情况和专业操作技能水平均得分明显高于对照组，两组比较差异有统计学意义(P<0.05)；患者与医生对研究组的满意度均明显高与对照组，两组比较差异有统计学意义(P<0.05)；研究组病区护理质量明显优于对照组，两组比较差有统计学意义(P<0.05)。结论护理组长在护理层级管理制度有起到了重要作用，有效促进护理人员专业知识应用，提高操作技能水平和患者的满意度。%Objective To analyze the role of nursing group leader in the implementation of the nursing level management system. Methods Selecting nursing staff of 60, divided into research group and the control group, 30 each, record the situa-tion of using two groups of nurses' professional knowledge, skills to the operation of the corresponding evaluation, compari-son of two groups of the assessment results and patient satisfaction. Results The team of nursing personnel of the profes-sional skills and professional knowledge level score significantly higher than the control group, two groups is significant dif-ference, statistically significant(P<0.05); Patients and doctors were significantly higher for the team's satisfaction with the control group, two groups is significant difference, statistically significant(P<0.05); Team ward nursing quality was better than control group, two groups are significant difference, statistically significant(P<0.05).Conclusion Nursing group leader in nursing
Muntaner, Carles; Li, Yong; Xue, Xiaonan; Thompson, Theresa; O'Campo, Patricia; Chung, Haejoo; Eaton, William W
This study simultaneously tests the effect of county, organizational, workplace, and individual level variables on depressive disorders among low-income nursing assistants employed in US nursing homes. A total of 482 observations are used from two waves of survey data collection, with an average two-year interval between initial and follow-up surveys. The overall response rate was 62 percent. The hierarchically structured data was analyzed using multilevel modeling to account for cross-classifications across levels of data. Nursing assistants working in nursing homes covered by a single union in three states were asked about aspects of their working conditions, job stress, physical and mental health status, individual and family health-care needs, household economics and household strain. The 241 nursing assistants who participated in this study were employed in 34 nursing homes and lived in 49 counties of West Virginia, Ohio and Kentucky. The study finds that emotional strain, related to providing direct care to elderly and disabled clients, is associated with depressive disorder, as is nursing home ownership type (for-profit versus not-for-profit). However, when controlling for county level socioeconomic variables (Gini index and proportion of African Americans living in the county), neither workplace nor organizational level variables were found to be statistically significant associated with depressive disorder. This study supports previous findings that emotional demand in health-care environments is an important correlate of mental health. It also adds empirical evidence to support a link between financial strain and depression in US women. While this study does not find that lack of a seniority wage benefits--a factor that can conceivably exacerbate financial strain over time--is associated with depressive disorder among low-income health-care workers, it does find county level measures of poverty to be statistically significant predictors of depressive
Boamah, Sheila A; Read, Emily A; Spence Laschinger, Heather K
To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. A time-lagged study of Canadian new graduate nurses was conducted. At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality. © 2016 John Wiley & Sons Ltd.
目的 了解中医院实习护生对中医护理知识与技能的掌握与需求情况.方法 采用自行设计的调查问卷,对北京市某三级中医院126名护生进行调查,对中医护理知识与技能的掌握与需求两方面情况进行分析.结果 护生中医护理知识平均得分为(7.53±2.97)分,92.9％的护生对中医护理.知识与技能学习的总体需求较大.结论 护生中医护理知识水平较低,临床操作实践机会较少,应建立有效教学机制,满足护生对中医护理知识与技能学习的较大需求,提高学校教育和临床教学质量.%Objective To investigate the nursing trainee' s mastery level and demand in knowledge and skills of Traditional Chinese Medical (TCM) nursing in a TCM hospital of Beijing.Methods Totals of 126 nursing trainees were investigated by a self-designed questionnaire on mastery level and demand in knowledge and skills of TCM nursing.Results The average score of TCM nursing knowledge of nursing trainees was (7.53 ±t2.97),and 92.9％ of them had large overall demand for knowledge and skills of TCM nursing.Conclusions Nursing trainees have low mastery level of knowledge of TCM nursing and little chance of practicing.It is necessary to set up effective teaching mechanism for meeting the need of nursing trainees and improving teaching quality of school and hospital.
... determinations generally make awards to: accredited schools of medicine, osteopathic medicine, public health, dentistry, veterinary medicine, optometry, pharmacy, allied health podiatric medicine, nursing, chiropractic, public or private nonprofit schools which offer graduate programs in behavioral health and mental health...
李燕玲; 胡敏; 丁洪琼
目的:调查护理实习生软技能水平,分析相关影响因素,并提出改善策略,以提高护生的综合素质和实习质量.方法:采用由付艳芬设计的护理软技能测评量表,对武汉协和医院316名护生进行问卷调查.结果:护生软技能总均分为(3.79±0.77)分,其中人际关系技能维度得分最高(3.91±0.29)分,组织管理技能最低(3.66±0.79)分.学历、父母文化程度以及是否班团干部是影响护生护理软技能的相关因素.结论:护生具有较高的护理软技能水平,建议护理院校及实习医院在认知技能和管理能力上为护生提供更多的锻炼机会,进一步提高护生的护理软技能水平.%Objective:To investigate soft skills level of nursing interns, analysis related factors and put forward improving strategies to improve the comprehensive quality of nursing students and practice of quality. Methods: A total of 316 nursing students from Wuhan Union Hospital were investigated by the Nursing Soft Skills Scale which designed by FU Yan-fen. Results:The mean score of nursing soft skills was (3. 79 ±0.77) . The dimension score of Interpersonal relationship (3. 91 ±0.29) was the highest and the dimension score of organization management (3. 66 ±0.79) was the lowest. Degree, the educational background of parents and class leaders were relating factors of soft skills. Conclusion: The soft skills of nursing students are at higher level. It is suggested that the nursing schools and teaching hospitals should provide more opportunities to practice at cognitive skills and management ability,so as to further improve their soft skills level.
Conclusion: Clinical advisers for nursing specialty graduate students in our survey were generally inexperienced with regarding to training and culturing nursing graduate students. These advisers were prepared for core teaching competency, but were not qualified to conduct scientific research. Based on these results, it would be beneficial to provide the clinical advisers more training on teaching cognition for graduate students and improve their competency to perform scientific research.
Nokwanda E. Bam
Full Text Available Background: Whilst the discourse of palliative care in HIV management is largely documented and regarded as being an essential component, various authors have further argued that within the context of HIV care in sub-Saharan Africa, palliative care and exploration of the dimensions thereof is largely lacking. This article presents the lived experiences of nurses involved in palliative care, thus providing the perspective of nurses and the multi-faceted dimensions of the nature of caring inherent. Objectives: This study explored the respondents’ understanding of the concepts ‘caring’ and ‘terminal patient’ and described the experiences of nurses caring for terminally-ill patients with HIV and how these experiences influence the nature of care rendered. Methods: Qualitative research using Husserl’s approach of phenomenology design underpinned the study and Giorgi’s steps of analysis were used to make meaning of the data. Results: The concept ‘caring’ was experienced by the nurses as transforming the patients’ quality of life through supportive care and hope for life. Palliative care made the nurses conscious of their own mortality, enabling them to be more sensitive, compassionate and dedicated to caring for their patients. The findings described the social networking that enabled nurses to collaborate with colleagues in the interdisciplinary teams and shared knowledge, skills and support within the palliative care team in order to optimise patient outcomes. Conclusion: Nurses with prolonged involvement in caring for terminally-ill patients with HIV experienced helplessness and emotional stress. Recommendations based on the results are that training in psychological and holistic care of the patient, professional counselling and stress management services are needed to support the nurse in this context.
Full Text Available Nurses have great potential to contribute to the development of health policy through political action. We undertook a systematic website review of international- and national-level professional nursing organizations to determine how they engaged registered nurses in health policy activities, including policy priority setting, policy goals and objectives, policy products, and mechanisms for engaging nurses in policy issues. We reviewed 38 organizations for eligibility and 15 organization websites met our inclusion criteria. Six professional nursing organizations had comprehensive websites with a discussion of specific policy goals and objectives, policy-related products and mechanisms for nurses to become engaged. Future research is needed to evaluate how nursing professional organizations establish policy priorities and to evaluate the effectiveness of the strategies used to politically engage nurses.