Hospital and unit characteristics associated with nursing turnover include skill mix but not staffing level: An observational cross-sectional study

BackgroundNursing 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.ObjectiveTo explore associations between nursing unit turnover rates and several hospital- and unit-level variables, including staffing level and skill mix.DesignObservational cross-sectional study of longitudinal data.Settings1884 nursing units in 306 U.S. acute care hospitals.MethodsDuring 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).ResultsGovernment 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.ConclusionsSeveral hospital and unit characteristic variables have significant associations with nursing turnover; these associations should be taken into account in nursing turnover research and need to be explored further. Controlling for hospital ownership, Magnet status, unit service line, and unit population age group, registered nurse skill mix is apparently more important than total nurse staffing level in predicting nursing turnover.     

Hospital nurse wages and staffing, 1977 to 2002: cycles of shortage and surplus

OBJECTIVE: The author reviews the causes of nursing shortages and surpluses and examines data from California hospitals to demonstrate how these cycles are expressed in the demand for and wages of nurses. BACKGROUND: Nursing shortages have been reported cyclically for more than 50 years in the United States. There has been little data analysis demonstrating the relationship between the current shortage and changes in wages and nurse staffing. METHODS: Analysis of longitudinal hospital and patient data from the California Office of Statewide Health Planning and Development. Summary statistics of patient utilization, nurse staffing, and nurse wages were computed. RESULTS: The data demonstrate that cyclical shortages are accompanied by higher wages and employment. This has been true in recent years. However, in medical-surgical units, hours per patient day declined between 2001 and 2002, perhaps reflecting the inability of hospitals to find more nurses to meet staffing goals. CONCLUSIONS: Nurse staffing per patient day and per discharge have remained stable, despite concerns about low staffing levels. Improved measures of patient care needs and studies of the precise staffing requirements for different types of patients and configurations of staff are required to make recommendations about staffing and policy.     

Understanding unassisted falls: effects of nurse staffing level and nursing staff characteristics

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.     

Searching: expectant fathers' experiences during labor and birth

When expectant fathers are present and view labor and birth as a couple experience, they are co-laboring in one of three roles: coach, teammate, or witness. Within these roles are various degrees and types of engagement. Men in the role of coach experience high degrees of physical and mental engagement. Teammates fluctuate between high and low degrees of physical and mental engagement, and witnesses remain at low degrees of engagement until the second stage of labor, when they experience high degrees of mental engagement. The expectant fathers' experience is influenced by the labor guides' activities of gatekeeping, leading, and informing. Men either maintain or redefine their role during labor and birth. Men who experience a sense of not belonging or who are uncomfortable with their role will redefine their role by using the strategy of searching for place. Searching for place involves the steps of identifying an alternative role, engaging in the new role, testing the role, and evaluating the effectiveness of the alternative role. Men who experience a sense of belonging in their new role will maintain this role. May posed the question, "Is it time to fire the coach?" This theory, which requires further testing and validation, does address May's question. Perhaps it is not time to fire the coach, as May indicated, but it is time to provide couples with options in the role expectant fathers play during labor and birth. This theory can guide nurses in relatively risk-free interventions for the expectant father. Nurses can assist expectant fathers in finding a place in labor and birth that will enhance a mutually satisfying birthing experience.     

Failure to rescue: implications for evaluating quality of care during labor and birth

Failure to rescue is an indicator that has been used to measure quality of care for surgical patients by evaluating the number of patients who die after developing postoperative complications. There are 2 key components of failure to rescue: (a) careful surveillance and timely identification of complications and (b) taking action by quickly initiating appropriate interventions and activating a team response. This concept has not been explored as a potential method to evaluate quality of intrapartum care. In obstetrics, complications leading to death are relatively rare because mothers and infants are generally healthy. Thus, there are not large numbers of maternal or infant deaths in individual hospitals or healthcare systems that allow the types of statistical analyses that have been previously used to measure failure to rescue rates. With modifications in the measurement process for failure to rescue in this population, there are direct implications for perinatal patient safety and lessons to be learned. A new use of the failure to rescue concept in a population not previously considered is proposed.     

The impact of California's staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis

BackgroundDespite the importance of adequate hospital nurse staffing, California is the only state with minimum nurse-to-patient ratio mandates. The health care workforce is historically “countercyclical”—exhibiting growth during economic recessions when employment in other sectors is shrinking.PurposeThis study was to examine how staffing mandates impact hospital nurse staffing during economic recessions.MethodWe compared hospital nurse staffing in California and in other states over 20 years to examine differences before and after the California mandate and, within the postmandate period, before, during, and after the Great Recession of 2008.FindingsStaffing differences increased during the postmandate period due to faster growth in California staffing compared to other states, except during the Great Recession, when staffing remained stable in California but declined in other states.DiscussionState legislators deliberating staffing mandates should consider the protective factor such policies provide during economic recessions and the implications for the quality and safety of care.     

妊娠期糖尿病患者分娩期的观察及护理

妊娠期糖尿病对母体及胎儿均有显著的不良影响,如不进行干预,产科并发症的发生率将增高~([1]).笔者通过对23例妊娠期糖尿病患者实施住院后护理,发现产科护士应具备完整的妊娠合并糖尿病的理论知识,做好孕妇心理护理及分娩前、分娩时、分娩后的护理,现报道如下.     

Neuraxial analgesia for labor and birth: implications for mother and fetus

Women are better educated today on issues related to labor and childbirth. Pain management options for the woman in labor have changed dramatically over the last decade. Systemic analgesia and dense-motor-blockade regional analgesia/anesthesia have become less common for childbirth while the use of newer neuraxial and regional techniques, with minimal motor blockade, have become more popular. The shift from regional anesthesia with significant motor-blockade during labor, where the woman is a passive participant during the labor and birth, to a collaborative approach for pain management, where the woman becomes an active participant, has resulted in a new philosophy of analgesia for labor and birth. This article provides a review of current neuraxial analgesia/anesthesia techniques used for pain management in labor and birth and their implications for the perinatal nurse.