A flexible nursing workforce: realities and fallouts

Using Agency Nurses to Fill RN Vacancies Within Specialized Hospice and Palliative Care

The use of agency nurses offers flexibility in filling registered nurse (RN) openings during times of shortage, yet little is known about their use in specialized palliative care. In an effort to fill this knowledge gap, this study determined whether significant relationships existed between full-time and part-time RN vacancies and the use of agency RNs within specialized hospices that deliver perinatal end-of-life care to women and their families in the event of miscarriage, ectopic pregnancy, or other neonatal complications resulting in death. This study used data from the 2007 National Home and Hospice Care Survey and multivariate regression methods to estimate the association between RN vacancies and agency RNs use. Approximately 13% of perinatal hospices in 2007 used agency nurses. Increases in full-time RN vacancies are associated with a significant increase in the use of agency RNs, while part-time RN vacancies are associated with a significant decrease in agency RNs. These results suggest that full-time agency RNs were used as a supplemental workforce to fill vacancies until the full-time position is recruited. However, for part-time vacancies, the responsibilities of those positions shifted onto existing staff and the position was not filled.

Analyzing the nursing organizational structure and process from a scheduling perspective

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.

Relationship-based nursing practice: transitioning to a new care delivery model in maternity units

In a fast-paced, high-volume maternity unit, the goal for nursing care delivery is to provide care that is perceived by patients as personal and caring, is rewarding to nurses, and is in an environment of maximum patient safety. A care delivery model is the organizing structure that can facilitate this goal. Relationship-Based Nursing Practice is a care delivery model designed to transition nursing care from task-focused to relationship-based. A shared vision of the registered nurse as a professional member of the healthcare team, working in an optimally safe and family-centered care environment, inspired the model design. Three relationships-the nurse with the patient, the nurse with colleagues, and the nurse with self-provided the foundation for the creation of guiding principles. Guiding principles were operationalized to support 1 or more of the 3 relationships, contribute to improved patient safety, and actualize the role of the professional registered nurse, in daily patient care. Outcomes include improvement in patient safety, increased patient satisfaction, and perception of improved teamwork among nurses. The process for sustainability and ongoing evaluation of the model is discussed.