Medical care employment in the United States, 1968 to 1993: The importance of health sector jobs for African Americans and women.

OBJECTIVES: The purpose of this study was to elucidate the social and economic impact of health sector employment. METHODS: US medical care employment was analyzed for each year between 1968 and 1993, with data from the March Current Population Survey. RESULTS: Between 1968 and 1993, medical care employment grew from 4.32 million to 11.40 million persons, accounting for 5.7% of all jobs in 1968 and 8.4% in 1993. Today, one seventh of employed women work in medical care; they hold 78% of medical care jobs. One fifth of all employed African-American women work in medical care. African-Americans hold 15.5% of jobs in the health sector: they hold 24.1% of the jobs in nursing homes, 15.9% of the jobs in hospitals, but only 5.6% of the jobs in practitioners' offices. Hispanics constitute 6.4% of medical care employees. Real wages rose 25% to 50% between 1968 and 1993 for most health occupations. Wages of registered nurses rose 86%; physicians' incomes rose 22%. Wages of nursing home workers were far lower than those of comparable hospital workers, and the gap has widened. In 1993, 11.7% of all medical care workers lacked health insurance and 597 000 lived in poverty. CONCLUSIONS: Hospital cuts and the continuing neglect of long-term care exacerbate unemployment and poverty among women and African Americans.     

Wellness: ten ways to make your workplace healthier

These 10 suggestions to make the workplace healthier are just a few ideas to get a health promotion or wellness program started. Employees are a great resource for ideas and suggestions, and unless the health care supervisor asks, the needs of the worker may remain unfulfilled. If a health care facility decides to initiate such a program, it will find that everyone will win. The employees will feel cared about and will, in return, care more about their jobs and responsibilities. Health care team members should be promoting health, not only for patients, but for themselves and their employees as well. In 1974, then Governor of North Carolina Terry Sanford said: "We need to invent and present more alternative approaches to health care, principally in teaching people how to care better for themselves, and the more difficult challenge--convincing them that they should." Institutions can start with their own health care employees, by making it easier for them to take better care of themselves.     

The benefits of a work-at-home program

Working from home offers the employee and the organization many benefits. The organization can use telework to recruit and retain valuable employees. The organization can also save money on work space and boost morale and loyalty. Employees enjoy the flexibility and convenience that telework offers. Teleworking is popular in the general business world and can be adapted to some jobs in the health care field. Managers must look throughout their organization to see what jobs can be accomplished either partially or completely at home.     

Satisfaction for health care employees: a quest for the Holy Grail?

This article proposes that, across industries, too much has been made of the importance of job satisfaction and its impact on organizational effectiveness. In addition, so much attention has been directed toward satisfaction that many health care employees, particularly nurses, now expect job satisfaction from their employers as an entitlement. In nursing, feelings about job satisfaction may, in fact, be exacerbated by the idealism which leads the young person entering the field to expect to be in a "helping profession" where workers almost automatically encounter the satisfaction that comes from giving the help which the patient desperately needs. Faced with the realities of long hours, grueling and often menial tasks, and sometimes churlish patients and physicians, the young nurse may, in fact, enter a period of deep dissatisfaction and of questioning nursing as a career choice. This situation is not unique to nurses. Many health care professionals face equally dissatisfying aspects of their jobs. Our focus is primarily on reducing job dissatisfaction, rather than improving job satisfaction, through practical solutions for those charged with attracting and retaining health care employees during tight labor markets.     

Psychohygiene in der ?Palliative Care“

Background

The mental strain for nursing staff in palliative care has been sufficiently described in recent years. However, in a nursing home, employees from other professional guilds are also active in the same context and often have intensive contact with the residents as well as with their relatives. It could already be shown that their mental strain does not differ from those of the nursing staff in several constructs. However, the special demands of palliative care were not considered in the past studies.

Aims

The present study tries to assess the effects of palliative settings on mental hygiene and compare nursing to non-nursing staff.

Methods

In the nursing home Mattenhof-Irchelpark, which belongs to the City of Zurich Nursing Homes, an enquiry by questionnaires was carried out among nursing and non-nursing staff. A total of 72 employees participated in this study. We examined the constructs ??contact with relatives?? and ??mental hygiene?? with a 7-point Likert scale.

Results

Employees from non-nursing divisions estimated their competence in ??contact with relatives?? to be significantly lower (p=0.005) and they felt equally burdened as the nursing staff. Analysis of the scale ??mental hygiene?? yielded significantly higher values of stress for the non-nursing staff in comparison to the nursing staff (p=0.022).

Conclusion

In summary, it can be stated that not only the nursing staff feels confronted with psychic challenges in the context of palliative care. Also employees from non-nursing areas perceive these challenges at least equally.     

Support in a time of need. The team approach at Mercy Medical Hospice addresses medical, emotional, and spiritual needs

Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. The entire team develops a care plan for the patient and family. Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives.     

Attractiveness of people‐centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home‐care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people‐centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home‐care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people‐centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home‐care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people‐centred, integrated home care as attractive. Specific aspects that home‐care nurses find attractive are promoting the patient′s self‐reliance and having a network in the community. Hospital nurses are mainly attracted to health‐related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home‐care nurses and a minority of hospital nurses feel attracted to people‐centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home‐care organisations who aim to expand the home‐care nursing workforce.     

The impact of Ontario's end-of-life care strategy on end-of-life care in the community

This article describes the impacts of the Ministry of Health and Long-Term Care's End-of-Life Care Strategy on the quality of end-of-life (EOL) care services delivered by home care providers across the province of Ontario. We compared key home care services one year before the strategy's implementation with those one year after. In addition, we conducted a qualitative survey of all community care access centres, the main providers of home care, and nearly all EOL Care Network directors to assess improvements to EOL care at the system and client level. Results showed that the number of clients of EOL care served increased by 3,537 over the baseline year. Moreover, the total number of nursing visits, shift nursing hours and personal support hours increased by 26%, 31% and 47%, respectively, compared with the baseline year. The qualitative analysis indicated that increased collaborations and communication have enhanced integration, coordination and consistency of EOL care. Anecdotally, clients and families feel more supported navigating the healthcare system, and more of their wishes are being met. The strategy appeared to improve EOL care on multiple levels. However, several barriers and challenges remain. Further investments and research are needed to achieve reliable quality EOL care for all Ontarians.     

Factors Explaining the Job Satisfaction of Home Care Workers Who Left Their Older Care Recipients in Israel

There are high levels of turnover among home care workers. The study goal was to examine factors connected with job satisfaction of home care workers who resigned from their jobs. A survey (self-administered questionnaire) was conducted of 197 home care workers who resigned from their jobs with a home care agency in Jerusalem. Overall job satisfaction of the home care workers was low to moderate. Memory impairment of the care recipient and quality of the relationship between the care worker and the care recipient were significant in explaining overall and intrinsic job satisfaction of the workers. Functional status (activities of daily living) and the impact of the care recipient’s cognitive status on the care worker were significant in explaining job benefit satisfaction. Home care workers who provide care to severely disabled and cognitively impaired older persons experience great work stress. They need ongoing support and training as well as better job benefits.     

Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care

Job dissatisfaction among nurses contributes to costly labor disputes, turnover, and risk to patients. Examining survey data from 95,499 nurses, we found much higher job dissatisfaction and burnout among nurses who were directly caring for patients in hospitals and nursing homes than among nurses working in other jobs or settings, such as the pharmaceutical industry. Strikingly, nurses are particularly dissatisfied with their health benefits, which highlights the need for a benefits review to make nurses' benefits more comparable to those of other white-collar employees. Patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out-a finding that signals problems with quality of care. Improving nurses' working conditions may improve both nurses' and patients' satisfaction as well as the quality of care.     

A study of patients receiving no billed nursing care

Although home health care traditionally is conceptualized as nursing care, in today's environment care at home may be delivered by a myriad of professional and nonprofessional practitioners. In fact, many patients who receive home care do not receive billed nursing visits. We studied a group of patients (n = 200) who received no billed nursing care, but rather received billed care from therapists, social workers and home health aides. This cohort of patients differed from patients who received billed nursing care in several ways: they were more frequently referred to home care from the community, their prognoses on admission to home care were significantly better, and their outcomes from home care services were considerably more favorable. Clearly patients not receiving billed nursing care have service and resource needs different from those of the population receiving billed nursing care. Therefore, new perspectives must be used when considering how to assess, deliver and perhaps pay for the requirements of these patients.     

How developmental supervision and performance management improve effectiveness

Health care supervisors play an important role in helping organizations achieve their goals by ensuring that employees perform their jobs as effectively and efficiently as possible. In most organizations, ill-defined and improperly designed systems exist for assessing and managing employee performance. Health care managers and supervisors can use knowledge of developmental supervision and performance management to increase employee job performance and satisfaction while providing useful information to human resource departments regarding training needs of employees.     

Retention: it's all about respect

Retention of employees is often overlooked in developing strategies to deal with worker shortages in health care. Managers mistake requests for more money as the key indicator of job satisfaction. This article examines research conducted by three health service administration graduate students who looked at reasons staff were leaving their jobs or their occupations. Using three different research tools, the students found that job satisfaction is not all about money, or even benefits. Respect, recognition, and organizational commitment are what employees want in their jobs. The article describes the research methods used in the studies and the similarities in results.     

An Exploration of Safety Climate in Nursing Homes

OBJECTIVES: Although nursing homes provide complex care requiring attention to safety, research on safety climate in nursing homes is limited. Our study assessed differences in attitudes about safety among nursing home personnel and piloted a new survey, specifically designed for the nursing home context. METHODS: Drawing on previous safety climate surveys for hospitals and nursing homes, researchers developed the Survey on Resident Safety in Nursing Homes and administered it March to June 2008 to frontline caregivers and managers in 8 randomly selected Massachusetts nursing homes. Our sample consisted of 751 employees, including all full-time, direct-care staff and managers from participating facilities. First, we performed factor analysis and determined Cronbach alphas for the Survey on Resident Safety in Nursing Homes. Then, we described facilities' safety climate and variation by personnel category and among facilities by calculating the proportion of responses that were strongly positive by item, personnel category, and nursing home. RESULTS: Of 432 respondents (57% response), 29% gave their nursing home an excellent rating overall. Scores varied by personnel category and home: 51% of senior managers gave an excellent safety grade versus 26% of nursing assistants; the range in top safety grades among nursing homes was 30 percentage points. CONCLUSIONS: Safety climate varied substantially among this small sample of nursing homes and by personnel category; managers had more positive perceptions about safety than frontline workers. Efforts to measure safety climate in nursing homes should include the full range of staff at a facility and comparisons among staff categories to provide a full understanding for decision making and to promote targeted response to improve resident safety.     

Home healthcare: a critical appraisal on nursing scientific production

The aim was to analyze the nursing scientific production concerning to home health care, from bibliography in electronic addresses of nursing journals, covering the period between 2000 and 2007. Two themes were identified: organization of home care and perceptions of caregivers and their families about the home care. There was the interest of authors in define concepts that reflect the ways of organizing the professional assistance in home and in identify the characteristics of caregivers and their families. In conclusion, the nursing has entered the care at home as the object of their search, but still so low, a fact which reinforces the need for expansion and dissemination of research of the profession.     

Characteristics of the clients in a geriatric intermediate care facility located in the suburbs of an urban area and factors related to the discharge destinations desired by family caregivers

Among the clients in a geriatric intermediate care facility located in the suburbs of Osaka and their family caregivers (72 subjects), the characteristics of the clients and their caregivers, and the discharge destination desired by their family caregivers were investigated, and the associated factors were evaluated. 1. Characteristics of the clients. The clients were elderly females with a low degree of independence, and dementia was observed in about 60% of them. The clients had a relatively large number of children, but many of them lived alone before admission. The rate of admission from hospitals was high (54%), and that of discharge to hospitals was also high (50%). Sixty-seven percent of the clients stayed for a long duration of over 6 months. 2. Conditions of the family caregivers. Most of the family caregivers were daughters or daughters-in-law, and considered themselves to be healthy. Sixty-three percent of the caregivers had jobs. However, most of the caregivers did not have sub-caregiver. 3. Factors related to the discharge destination desired by family caregivers. Not many family caregivers (19.4%) wanted them to go back to their homes after discharge, but their preferred discharge destinations were home (19.4%), hospitals (55.5%), and nursing homes (25.1%). The caregivers of single household clients often desired a nursing home as the discharge destination, and those of the clients from a 2- or 3-generation household often desired a hospital. The factors related to the discharge destination desired by client's family caregivers were that the client not show dementia, the job of the caregiver was a part-time job, there was a sub-caregiver, and the client had the experience of home public health nursing visits. This study showed, the percentage of the clients discharged from the geriatric intermediate care facility to their homes was low, and that of the family caregivers who desired their home as the discharge destination was also low. However, the results suggested that leading the discharge destination to the client's home is possible if social resources are provided such as the use of public health nursing services.     

What happens to retirees after health care reform?

The advent of health care reform may cause older workers, no longer fearful of losing health benefits, to leave their jobs. Employers that want to retain these valuable employees may ultimately need to upgrade pay and benefits.     

Issues and opportunities in the regulation of home health care.

Recent federal legislation established a Certificate of Need (CON) process by which health care providers must receive state approval before building or renovating a facility, or adding a new service. Certainly, strict regulation of cost and quality of home health care is needed, but it is asserted that CON is an ineffective way of organizing the delivery of services and limiting costs, and furthermore, that CON is biased in favor of institutionally-based providers and maintenance of the status quo. The authors feel that vested interests have a history of trying to use earlier state CON regulations to control their turf, limit competition, and consequently stifle innovation. Home health care should be incorporated into national health planning goals and integrated into state and regional health plans. Such planning must precede CON regulations and should not be confused with it. Alternatives to CON can achieve quality service and moderate costs and include licensing of personnel, standards for provider accreditation, and utilization review. Planning for these alternatives should begin now to avoid fragmented expansion of home health care. Evidence suggests a comprehensive use of home health care as a cost-effective alternative for many levels of care given in hospitals and nursing homes.     

When you lose your job in health care management

In the present age of downsizing in health care, many health care professionals are losing their jobs. This significantly affects both the physical and psychological health of the person who has lost the job. Additionally, those left on the job are likely to feel insecure and fearful that their job may also be threatened. This article presents guidelines for coping with the loss of a job and how to aggressively seek a new one.