Patient turnover and nursing staff adequacy

OBJECTIVE: To assess the relative validity of patient turnover adjustments and the difference in nurse staffing using measures that adjust for patient turnover and severity versus those that do not. DATA SOURCES: Numbers of registered nurses (RNs), adjusted patient days of care (APDC), length of stay, and patient severity information from acute care general hospitals in Pennsylvania 1994-2001, obtained from the Pennsylvania Department of Health, the American Hospital Association, and the Atlas MediQual system. STUDY DESIGN: After examining the trends in patient turnover and severity and their relationship to RN staffing, we apply two-patient turnover indices, with and without patient severity adjustments, to RN staffing measures, and test the difference between the original and adjusted measures using paired sample t-tests. DATA EXTRACTION METHODS: Data sets were match merged by hospital ID, and patient turnover and severity indices were created, using 1994 as the base year. RN staffing measures were developed using unadjusted APDC, and APDC adjusted for patient turnover and both patient turnover and severity. PRINCIPAL FINDINGS: Patient turnover increased significantly from 1994 to 2001. The difference between RN staffing measures adjusted for patient turnover and severity and those not adjusted was increasingly significant from 1995 onward. Unadjusted RN staffing showed a 1 percent decline over the 8-year-period compared with decreases of from 9 to 26 percent after adjustments. CONCLUSIONS: These results indicate that the assessment of unadjusted RN staffing by RN to patient ratios alone underestimates nursing workload and overstates RN staffing levels. Patient turnover, as well as severity, should be taken into account in staffing assessment and decision making.     

Implementation of hospital restructuring and nursing staff perceptions of hospital functioning

Hospital restructuring and downsizing has taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff, as well as features of the restructuring process that contribute to more effective transitions. This research reports results of a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital effectiveness. Data were collected in November 1996 and again in November 1999 from nursing staff using questionnaires. Would the way hospital restructuring was implemented and managed in 1996 be related to nursing staff perceptions of hospital functioning in 1999? The findings showed positive but moderate relationships between more favorable restructuring processes and perceptions of hospital functioning.     

A holistic approach to supporting staff in a pediatric hospital setting

Health care professionals experience significant stress in the workplace. Building opportunities for health care professionals to manage stress is essential. Children's Hospital of Wisconsin designed a holistic set of programs called the R&R Series to support the emotional, cognitive, and spiritual health of staff and assist staff in using self-care strategies to build resiliency. Six hundred seventy program evaluations were collected during a 1-year pilot series. Program participants were from a wide variety of departments throughout the health care system. Staff reported feeling more supported, being better able to manage work and life stress, and practicing the self-care techniques they learned. Programs such as the R&R Series are one way to promote the overall health and resiliency of health care professionals.     

A study of child care staff turnover

This study grew out of the concern for the high level of child care turnover existing in group care facilities. The results indicate that demographic variables are far superior in predicting turnover than organizational factors. The demographic variable most closely associated with turnover is found to be age. Controlling for tenure revealed that during the first two years of employment, a child care worker's rationale for leaving his job changes based on the number of months he has been employed. The study also revealed that previous studies pertaining to job satisfaction appear to apply only to child care staff in residential settings who are 26 years of age or older.This is a more detailed and comprehensive report of a study initially outlined elsewhere (Ross, 1983).     

Estimating the nursing staff required in a new hospital

Opening a new hospital poses a complex and consequential set of challenges. One of these challenges is to estimate the nursing staff. The aim of this article is to report the entire process adopted to estimate the required nursing staff for a new Hospital in Brazil. The nursing staff was projected according to the Brazilian Federal Nursing Council (Cofen). We applied an equation to estimate nursing staff and compared the results with two other existing hospitals. A significant difference (p<0.05) was observed when comparing the Nurse-License Practice Nurse ratio recommended by Cofen between the new Hospital and other hospitals. This statistical difference is mostly due to reduced nurse staff in intensive care units. Almost one year after the hospital opened its doors, it is necessary to review nursing staff hours with the real information to reinforce the expenditure on these personnel and to evaluate the decisions made so far.     

乡镇卫生院护理人员工作现状及离职意愿研究

目的:描述乡镇卫生院护理人员工作现状和离职意愿,并分析工作量和工作内容对离职意愿的影响,为改善基层护理工作提出建议。方法:采用多阶段分层整群随机抽样,对我国三个省45家乡镇卫生院的167名护理人员进行问卷调查,并深度访谈44名护理人员。结果:深化医改以来,农村基层护理人员工作量增加,62%认为自己的工作量大。护理工作占护理人员平均工作时间的60%;公共卫生服务工作占平均工作时间的21%。30%的被调查者具有离职意愿。在控制省份、工作量、婚姻状况、编制、文化程度和从医年限等混杂因素后,公共卫生服务参与情况与护理人员离职意愿显著相关(P0.05)。结论:医改后乡镇卫生院护理人员工作内容扩展、工作量增加,工作内容的扩展降低了护理人员的离职意愿。     

温州市综合医院ICU护士留职意愿的调查与探讨

目的：了解综合医院ICU护士留职意愿,为管理者留住护理人才提供理论参考。方法：采用Leanne Cowin编制的留职意愿量表对温州市综合医院ICU护理人员进行问卷调查,对收集的资料采用office 2003 Excel软件进行录入,采用SPSS12.0软件进行分析,使用方差分析进行统计推断。结果：温州市综合医院ICU护士的留职意愿处于低于温州市护理人员的留职意愿,特别是高职称、高学历的护士留职意愿较低。结论：温州市综合医院ICU护士的留职意愿低于温州市护理人员的留职意愿,管理者应提升ICU护士的收入、注重高职称、高学历护士的发展、推行人性化管理模式有助于提升护士留职意愿水平。     

Correlates of nursing staff survivor responses to hospital restructuring and downsizing

This study examines correlates of 4 archetypal survivor responses to organizational restructuring and downsizing proposed by Mishra and Spreitzer: hopeful, obliging, cynical, and fearful. Data were collected from 744 long-term nursing staff survivors of hospital restructuring and downsizing using questionnaires. Three types of correlates were considered: work outcomes, indicators of psychologic well-being, and perceptions of hospital functioning. Greater endorsement of cynical and fearful restructuring responses was associated with more negative work outcomes and lower psychologic well-being. Greater endorsement of both cynical and fearful responses was also found to be associated with more negative perceptions of hospital functioning and effectiveness.     

General hospital psychiatric wards: facilities and performance of nursing staff

This article contains an essay on General Hospital Psychiatric Wards. Authors describe the experiences regarding the implementation of Psychiatric Wards, pointing out questions about the tolerance with psychiatric patients at a general hospital and the performance of the nursing staff. Authors read some works, articles, theses and dissertations produced in Brazil in the last ten years. The analysis of these experiences was based on the Psychiatric Reform, "paradigmatic transition" concepts, the psychosocial field of awareness and reflections on the role of a nurse. Authors believe that these initiatives are directed to create a space of inclusion of the psychiatric patient in the society, generating proposals to change mental health nursing, through the construction of ethical, professional, therapeutic, flexible practices committed with the care.     

Burnout syndrome among nursing staff at a hospital in Madrid

BACKGROUND: The term "burnout" is related to a situation arising increasingly more often among the professionals performing their duties by way of a long-term, direct, people-to-people relationship, which includes all healthcare professionals. This study is aimed at determining the prevalence of the Burnout syndrome and of the three components involved therein (emotional exhaustion, impersonalization and lack of personal fulfillment) among the nursing staff at the "Hospital Clínico Universitario San Carlos" in Madrid and the relationship thereof to certain socio-demographic, job-related and institutional factors. METHODS: A cross-sectional study was conducted among the professionals assigned to the nursing staff at the above-mentioned hospital. The variables involved were gathered by means of a questionnaire prepared by those conducting this study. The Burnout syndrome was measured by means of the Maslach Burnout Inventory, in the validated Spanish version thereof. RESULTS: The nursing staff is more impersonalized (p=0.004) and less fulfilled (p=0.036) than the nursing assistant/technician group. When the results of the four scales by units were analyzed, burnout was found to be greater among the nursing staff assigned to oncology and emergency care units (p=0.001), the impersonalization in the emergency rooms (p=0.007), and Burnout is once again greater in the oncology and emergency units (p=0.000). Those professionals who answered that there was little recognition of their nursing care scored worst regarding Burnout and the three aspects thereof (p =0.000). The lower the degree of on-the-job satisfaction, the higher the scores on the four scales (p=0.000). CONCLUSIONS: The conclusion which may be drawn from this study is that the profile of a person affected by Burnout is that of a professional with on-the-job experience who nevertheless considers very little recognition to be given to their caregiving and a high degree of dissatisfaction with the way in which their workplaces are managed.     

Validation of the Job Content Questionnaire in hospital nursing staff

OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.     

The basic and advanced cardiopulmonary resuscitation skills of trained hospital nursing staff

The cardiopulmonary resuscitation skills of 105 trained hospital nurses were tested. Both basic and, for the first time in the UK, advanced skills were examined; basic skills were assessed by practical evaluation with a standard manikin and advanced knowledge by multiple choice questionnaire. No nurse adequately performed all four practical skills tested. Knowledge of the ventilatory aspects of resuscitation, defibrillation and advanced technique and drug management were also found to be poor. The findings add further support to adequate training of nurses in resuscitation skills. We describe a solution to overcome the heavy demands of such teaching and suggest that the same model be applied to the training of medical staff in resuscitation skills.