Satisfaction with a new model of professional practice in critical care

Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center

BACKGROUND

This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China.

METHODS

Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded.

RESULTS

No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection.

CONCLUSIONS

NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.

A Multi-Factor Analysis of Job Satisfaction Among School Nurses

Although job satisfaction has been widely studied among registered nurses working in traditional health care settings, little is known about the job-related values and perceptions of nurses working in school systems. Job satisfaction is linked to lower levels of job-related stress, burnout, and career abandonment among nurses. This study evaluated the level of job satisfaction among a convenience sample of school nurses practicing in California. The Index of Work Satisfaction (IWS) was the instrument used. Although the sampled school nurses rated autonomy and interaction as the most important and satisfying factors contributing to job satisfaction, the overall findings indicated that school nurses are relatively dissatisfied with their jobs.

The skill mix model: a preliminary study of changing nurse role functions in Taiwan

BACKGROUND

: Nursing shortage is a critical problem worldwide. Using nurse aides (NAs) within a skill mix model has been applied in the healthcare delivery system as a strategy to improve nursing workforce shortages.

PURPOSE

: The purpose of this study was to investigate changes in nurse perceptions of their role functions under the skill mix model in Taiwan.

METHODS

: This was a cross-sectional designed study that employed a structured questionnaire. Participants included 38 registered nurses from three medical wards in three hospitals that had implemented the skill mix model for 6 months. The questionnaire gathered data on participant demographics, perceptions on the role functions, role and job satisfaction of nurses, and patient care quality. Nurses' role functions were grouped into independent, dependent, and interdependent categories.

RESULTS

: Results demonstrate that nurses' perceptions of independent and interdependent role function have changed since the implementation of the skill mix model. The most significant role changes in the independent function category included the nurse as educator of NAs, supervisor for patient care, and evaluator for nursing care outcomes. The most significant role changes in the interdependent function category included the nurse as integrator of nursing work and coordinator of the healthcare team. Nurses' perceived changes increase in repetitive confirmation of patient conditions and patient care quality.

CONCLUSIONS

: This study revealed that nurses working in skill mix model environments need more authority to delegate and educate NAs and to supervise and integrate nursing care. Study results may serve as a reference for hospital nursing practice in Taiwan.

The skill mix practice model for nursing: measuring outcome

AIM

This paper reports a study examining the outcome of personnel costs and quality of care after implementing the skill mix practice model for nursing.

BACKGROUND

In response to ever-tightening government budgets and changes in health insurance reimbursement, it may be necessary for hospitals to reassess their practice models to remain competitive and maintain quality of care.

METHOD

Using a pre- and post-test quasi-experimental design with questionnaires, participants were recruited at a teaching hospital in Taiwan. Questions were included on both patient satisfaction with nursing care and nurse satisfaction with nursing aides. The data were collected in 2003.

RESULTS

The cost of implementing the skill mix practice model with 22 nurses and seven nursing aides was 2.7% lower than when only using 25 nurses. In addition, there was a statistically significant difference in patient satisfaction and in nurse satisfaction with the performance of the aides. There was no statistically significant difference in the pre- and post-test outcome measures of both the incidence of falls and the medication error rate.

CONCLUSION

To decrease costs and increase quality of care, the skill mix practice model is worthy of consideration for clinical nursing care. This study presents an investigation of the first hospital implementation of the skill mix practice model for nursing in Taiwan, and the results of which can serve as a reference model for hospital nursing practice reform.

The nursing shortage in acute and critical care settings

The nursing shortage is seriously challenging hospitals to provide safe, quality care to acute and critically ill patients. Most frequently reported are the registered nurse (RN) shortages in intensive care units (ICUs) and step-down units. Issues surrounding the nursing shortage are multifaceted and require comprehensive solutions. Although work place conditions are typically cited as the leading cause of the shortages, other factors, including a rapidly aging RN workforce, have been implicated. Furthermore, fewer young people are choosing nursing as a career and graduating classes of RNs are decreasing in size. Remedies for the acute and critical care nursing shortage will require highly innovative initiatives and multiple long-term strategies focused on forces driving the growing nursing shortage. One solution to workplace issues may lie in the philosophy of the Magnet Hospital program. The advanced practice nurse can play a significant role in providing leadership in addressing factors and designing comprehensive and innovative strategies directed at recruitment and retention of RNs in acute and critical care settings.

The California experiment: alternatives for minimum nurse-to-patient ratios

In making policy, it is ideal to study a problem, test solutions, and then implement the best solution. In California there is legislation regarding nurse staffing that requires implementation of a solution before the problem has been accurately stated and before alternative solutions have been tested. Assembly Bill 394 directs the California Department of Health Services to establish "minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit" and have these ratios in place January 1, 2002. This law is scheduled for implementation before there is specific evidence of optimal staffing levels for various patient populations. The author presents a comprehensive literature review of activities related to nurse staffing in the United States, provides data related to existing patient classification systems in California, and suggests an alternative to staffing ratios to protect consumers.

Patient satisfaction in ambulatory surgery

The purpose of this study was to explore the relationships between patient satisfaction and selected variables that were identified as important in ambulatory surgery. The study addressed whether the selected variables are associated with the satisfaction of patients admitted to the hospital for ambulatory surgery. A descriptive correlational study was conducted in two hospital settings with 130 ambulatory surgical patients. Nurses (n = 16) in the ambulatory surgery departments completed a nurse demographic data form. The patient sample differed between settings in age, diagnosis, and use of computers. The nurse sample differed in the number of nurses with computers in their homes and their satisfaction with nursing. Results showed that patients' higher ratings of postoperative pain correlated with higher patient satisfaction. Patients with high postoperative pain rated satisfaction with pain management lower. A point biserial correlation (rpb = .22) indicated a significant correlation between patient satisfaction and nurses' use of computers to collect and record patient information (P = .01). The patient sample in the setting where computers were used showed a higher mean patient satisfaction.

Factors influencing job valuation: a comparative study of critical care and non-critical care nurses

This study sought to identify the relationship between three predictor variables, perceived collaboration with medical staff, autonomy and independent actions and an outcome, the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical care nurses perceived themselves to have a more collaborative relationship with the medical staff, described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more, however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work.

Review of magnet hospital research: findings and implications for professional nursing practice

The label "magnet hospitals" originally was given to a group of U.S. hospitals that were able to successfully recruit and retain professional nurses during a national nursing shortage in the early 1980s. Studies of magnet hospitals illuminated the leadership characteristics and professional practice attributes of nurses within these organizations. Recent investigations within magnet hospitals document significant relationships between nursing and patient outcomes, including mortality and patient satisfaction. The purpose of this review is to: 1) synthesize the magnet hospital research that describes and evaluates the professional practice of nurses within these institutions and (2) identify areas for future research to advance professional nursing models within current hospital organizations.

Problems associated with nursing staff shortage: an analysis of the first 3600 incident reports submitted to the Australian Incident Monitoring Study (AIMS-ICU)

Although many studies have attempted to define appropriate nursing staff levels, allocation and patient dependency, minimal data is available on the effect of nursing staff shortage (NSS) on quality of care provided in intensive care. This study aimed to identify incidents associated with staff shortage as reported to the Australian Incident Monitoring Study-ICU (AIMS-ICU) project and to assess their estimated effect on patient outcome. A search of narrative keywords and contributing factors identified 89 nursing staff shortage incidents (NSS-INCIDENTS) and 373 incidents involving nursing staff shortage contributing factors (NSS-CF). NSS resulted from inappropriate rostering for current patient load (81%) and inability to respond to increased unit activity (19%). Most frequent associated incidents included problems with: drug administration/documentation (47), patient supervision (20), set-up of ventilators/equipment (16), and accidental extubation (14). Undesirable patient outcomes included: major physiological change (22%), patient/relative dissatisfaction (12%), and physical injury (3%). This study suggests that inadequate staffing results in incidents and compromised patient safety.