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Simpson RL, Lee JA, Li Y, Kang YJ, Tsui C, Cimiotti JP. Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data. JAMIA Open 2024; 7:ooae007. [PMID: 38344670 PMCID: PMC10856805 DOI: 10.1093/jamiaopen/ooae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/05/2023] [Accepted: 01/13/2024] [Indexed: 02/18/2024] Open
Abstract
Introduction Cloud-based solutions are a modern-day necessity for data intense computing. This case report describes in detail the development and implementation of Amazon Web Services (AWS) at Emory-a secure, reliable, and scalable platform to store and analyze identifiable research data from the Centers for Medicare and Medicaid Services (CMS). Materials and Methods Interdisciplinary teams from CMS, MBL Technologies, and Emory University collaborated to ensure compliance with CMS policy that consolidates laws, regulations, and other drivers of information security and privacy. Results A dedicated team of individuals ensured successful transition from a physical storage server to a cloud-based environment. This included implementing access controls, vulnerability scanning, and audit logs that are reviewed regularly with a remediation plan. User adaptation required specific training to overcome the challenges of cloud computing. Conclusion Challenges created opportunities for lessons learned through the creation of an end-product accepted by CMS and shared across disciplines university-wide.
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Affiliation(s)
- Roy L Simpson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States
| | - Joseph A Lee
- Harvard University, Boston, MA 02138, United States
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States
| | - Yu Jin Kang
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA 30303, United States
| | - Circe Tsui
- Office of Information Technology, Emory University, Atlanta, GA 30322, United States
| | - Jeannie P Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States
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2
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Gao G, Vaclavik L, Jeffery AD, Koch EC, Schafer K, Cimiotti JP, Pathak N, Duva I, Martin CL, Simpson RL. Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives. Appl Clin Inform 2024; 15:26-33. [PMID: 37945000 PMCID: PMC10830245 DOI: 10.1055/a-2207-7396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap. OBJECTIVES This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process. METHODS We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories. RESULTS The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales. CONCLUSION This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.
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Affiliation(s)
- Grace Gao
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
- School of Nursing, St Catherine University, St Paul, Minnesota, United States
| | - Lindsay Vaclavik
- Department of Internal Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, United States
| | - Alvin D. Jeffery
- Office of Nursing Services, Tennessee Valley Healthcare System, Nashville, Tennessee, United States
- Vanderbilt University School of Nursing, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Erica C. Koch
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Katherine Schafer
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Jeannie P. Cimiotti
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Neha Pathak
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
| | - Ingrid Duva
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Christie L. Martin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Roy L. Simpson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
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3
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Gao G, Vaclavik L, Jeffery AD, Koch EC, Schafer K, Cimiotti JP, Pathak N, Duva I, Martin CL, Simpson RL. Developing a Quality Improvement Implementation Taxonomy for Organizational Employee Wellness Initiatives. Appl Clin Inform 2024; 15:26-33. [PMID: 38198827 PMCID: PMC10781573 DOI: 10.1055/s-0043-1777455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Standardized taxonomies (STs) facilitate knowledge representation and semantic interoperability within health care provision and research. However, a gap exists in capturing knowledge representation to classify, quantify, qualify, and codify the intersection of evidence and quality improvement (QI) implementation. This interprofessional case report leverages a novel semantic and ontological approach to bridge this gap. OBJECTIVES This report had two objectives. First, it aimed to synthesize implementation barrier and facilitator data from employee wellness QI initiatives across Veteran Affairs health care systems through a semantic and ontological approach. Second, it introduced an original framework of this use-case-based taxonomy on implementation barriers and facilitators within a QI process. METHODS We synthesized terms from combined datasets of all-site implementation barriers and facilitators through QI cause-and-effect analysis and qualitative thematic analysis. We developed the Quality Improvement and Implementation Taxonomy (QIIT) classification scheme to categorize synthesized terms and structure. This framework employed a semantic and ontological approach. It was built upon existing terms and models from the QI Plan, Do, Study, Act phases, the Consolidated Framework for Implementation Research domains, and the fishbone cause-and-effect categories. RESULTS The QIIT followed a hierarchical and relational classification scheme. Its taxonomy was linked to four QI Phases, five Implementing Domains, and six Conceptual Determinants modified by customizable Descriptors and Binary or Likert Attribute Scales. CONCLUSION This case report introduces a novel approach to standardize the process and taxonomy to describe evidence translation to QI implementation barriers and facilitators. This classification scheme reduces redundancy and allows semantic agreements on concepts and ontological knowledge representation. Integrating existing taxonomies and models enhances the efficiency of reusing well-developed taxonomies and relationship modeling among constructs. Ultimately, employing STs helps generate comparable and sharable QI evaluations for forecast, leading to sustainable implementation with clinically informed innovative solutions.
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Affiliation(s)
- Grace Gao
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
- School of Nursing, St Catherine University, St Paul, Minnesota, United States
| | - Lindsay Vaclavik
- Department of Internal Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, United States
| | - Alvin D. Jeffery
- Office of Nursing Services, Tennessee Valley Healthcare System, Nashville, Tennessee, United States
- Vanderbilt University School of Nursing, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Erica C. Koch
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Katherine Schafer
- Veteran Affairs Quality Scholars Program, Tennessee Valley VA Healthcare System, Nashville, Tennessee, United States, Clinical Instructor of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Jeannie P. Cimiotti
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Neha Pathak
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
| | - Ingrid Duva
- Veteran Affairs Quality Scholars Program, Joseph Maxwell Cleland Atlanta VA Medical Center, Atlanta, Georgia, United States
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
| | - Christie L. Martin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Roy L. Simpson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
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Kavanagh KT, Maiwald M, Pontus C, Cimiotti JP, Palmieri PA, Cormier LE. Frontline Worker Safety in the Age of COVID-19: A Global Perspective. J Patient Saf 2023; 19:293-299. [PMID: 37162150 PMCID: PMC10373843 DOI: 10.1097/pts.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The third annual Health Watch USA sm webinar conference assembled 16 speakers from 4 continents who shared information regarding frontline worker safety in the age of COVID-19. The U.S. Bureau of Labor Statistics reported a nearly 4000% increase in workplace illness in 2020 compared with 2019. It is estimated that 2% of the U.S. workforce is not working because of long COVID. In addition, the impact is growing with each surge. After the acute illness, patients are often described as recovered, when in fact many have only survived and are coping with the multisystem impacts of long COVID. Long COVID, including its late cognitive, cardiovascular, embolic, and diabetic complications, disproportionately impacts frontline workers, many of whom are of lower socioeconomic status and represented by ethnic minorities. Natural infection and current vaccines do not provide durable protection for reinfection. Herd immunity is not possible at this time. Although SARS-CoV-2 is unlikely to be eliminated, decreasing spread is imperative to slow the rate of mutations, decrease the number of reinfections, and lower the chances of developing long COVID. The primary mode of spread is through aerosolization. Both routine breathing and talking aerosolizes the virus. With the extremely high infectivity of SARS-CoV-2, it is unlikely that central building ventilation alone will be enough to satisfactorily mitigate spread. Additional safe active air cleaning technology, such as upper-room germicidal UV-C lighting, needs to be deployed. Misinformation and disinformation have inhibited response effectiveness. Examples include downplaying the benefit of well-fitted masks and the risks that COVID-19 and long COVID pose to children, along with believing children cannot spread the disease. The engagement of local community leaders is essential to educate the community and drive social change to accept vaccinations and other public health interventions. Vaccinations and natural immunity alone are unlikely to adequately prevent community spread and do not provide durable protection against the risk of long COVID. Frontline workers must keep their immunity as high as possible and work in settings with clean air, along with wearing N95 masks when they are in contact with the public. Finally, there needs to be a financial safety net for frontline workers and their families in the event of incapacitation or death from COVID-19.
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Affiliation(s)
| | - Matthias Maiwald
- KK Women’s and Children’s Hospital
- Yong Loo Lin School of Medicine, National University of Singapore
- Duke-National University of Singapore Graduate School of Medicine, Health Watch USA, Singapore
| | - Christine Pontus
- Massachusetts Nurses Association, United States, Health Watch USA Canton, Massachusetts
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Alemu W, Cimiotti JP. Meta-Analysis of Medication Administration Errors in African Hospitals. J Healthc Qual 2023; 45:233-241. [PMID: 37276257 DOI: 10.1097/jhq.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT The incidence of medication administration errors (MAEs) and associated patient harm continue to plague hospitals worldwide. Moreover, there is a lack of evidence to address this problem, especially in Africa. This research synthesis was intended to provide current evidence to decrease the incidence of MAEs in Africa. Standardized search criteria were used to identify primary studies that reported the incidence and/or predictors of MAEs in Africa. Included studies met specifications and were validated with a quality-appraisal tool. The pooled incidence of MAEs in African hospitals was estimated to be 0.56 (CI: 0.4324-0.6770) with a 0.13-0.93 prediction interval. The primary estimates were highly heterogeneous. Most MAEs are explained by system failure and patient factors. The contribution of system factors can be minimized through adequate and ongoing training of nurses on the aspects of safe medication administration. In addition, ensuring the availability of drug use guidelines in hospitals, and minimizing disruptions during the medication process can decrease the incidence of MAEs in Africa.
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Jung OS, Aiken LH, Sloane DM, Fridkin SK, Li Y, Kang YJ, Becker ER, Joski PJ, Cimiotti JP. Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection. Med Care 2023; 61:360-365. [PMID: 37167557 PMCID: PMC10168114 DOI: 10.1097/mlr.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Clostridioides difficile is the leading cause of hospital-onset diarrhea and is associated with increased lengths of stay and mortality. While some hospitals have successfully reduced the burden of C. difficile infection (CDI), many still struggle to reduce hospital-onset CDI. Nurses-because of their close proximity to patients-are an important resource in the prevention of hospital-onset CDI. OBJECTIVE Determine whether there is an association between the nurse work environment and hospital-onset CDI. METHODS Survey data of 2016 were available from 15,982 nurses employed in 353 acute care hospitals. These data, aggregated to the hospital level, provided measures of the nurse work environments. They were merged with 2016 hospital-onset CDI data from Hospital Compare, which provided our outcome measure-whether a hospital had a standardized infection ratio (SIR) above or below the national average SIR. Hospitals above the average SIR had more infections than predicted when compared to the national average. RESULTS In all, 188 hospitals (53%) had SIRs higher than the national average. The odds of hospitals having higher than average SIRs were significantly lower, with odds ratios ranging from 0.35 to 0.45, in hospitals in the highest quartile for all four nurse work environment subscales (managerial support, nurse participation in hospital governance, physician-nurse relations, and adequate staffing) than in hospitals in the lowest quartile. CONCLUSIONS Findings show an association between the work environment of nurses and hospital-onset CDI. A promising strategy to lower hospital-onset CDI and other infections is a serious and sustained commitment by hospital leaders to significantly improve nurse work environments.
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Affiliation(s)
- Olivia S. Jung
- Rollins School of Public Health, Emory University, Atlanta, GA
- Laboratory of Innovation Science at Harvard, Harvard University, Cambridge
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Scott K. Fridkin
- Rollins School of Public Health, Emory University, Atlanta, GA
- School of Medicine, Emory University
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Yu Jin Kang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Peter J. Joski
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeannie P. Cimiotti
- Rollins School of Public Health, Emory University, Atlanta, GA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Giordano NA, Swan BA, Johnson TM, Cimiotti JP, Muirhead L, Wallace M, Mascaro JS. Scalable and sustainable approaches to address the well-being of healthcare personnel. J Adv Nurs 2023; 79:e12-e15. [PMID: 36426720 PMCID: PMC9877157 DOI: 10.1111/jan.15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Beth Ann Swan
- Emory University Nell Hodgson Woodruff School of Nursing, Georgia, Atlanta, USA
| | - Theodore M. Johnson
- General Internal Medicine, Emory University School of Medicine, Georgia, Atlanta, US
- Birmingham/Atlanta VA Geriatrics Rehabilitation, Education, and Clinical Center, Atlanta Veterans Affairs Healthcare System, Georgia, Atlanta, USA
- Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Georgia, Atlanta, USA
| | - Jeannie P. Cimiotti
- Emory University Nell Hodgson Woodruff School of Nursing, Georgia, Atlanta, USA
| | - Lisa Muirhead
- Emory University Nell Hodgson Woodruff School of Nursing, Georgia, Atlanta, USA
| | | | - Jennifer S. Mascaro
- Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Georgia, Atlanta, USA
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Li Y, Howell JR, Cimiotti JP. Nurse practitioner job preference: A discrete choice experiment. Int J Nurs Stud 2023; 138:104407. [PMID: 36481595 PMCID: PMC9671868 DOI: 10.1016/j.ijnurstu.2022.104407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nurse practitioners play a critical role in improving the access to care and in meeting the needs for health care. However, prior to the COVID-19 pandemic, the average turnover rate of nurse practitioners was 10 % with associated total direct cost that ranged from $85,832 to $114,919 for each episode of turnover in the United States. Little is known about the job preference of nurse practitioners and the cost savings to an organization that provides jobs with characteristics attractive to nurse practitioners. OBJECTIVE The aim of this study was to identify the preferred job characteristics that are associated with nurse practitioners' job choices; and to determine the extent to which nurse practitioners would need to be compensated for practicing without these characteristics. DESIGN A two-stage design using a mixed method approach. SETTING(S) The state of Georgia in the United States. PARTICIPANTS 2757 nurse practitioners who were actively licensed were invited to participate. Of the 412 participants, 372 actively employed in Georgia were included in the analysis. METHODS A 2-stage discrete choice experiment was designed. Stage-1 was a qualitative design using a focus group to identify nurse practitioners' preferred job characteristics. Stage-2 was a quantitative design using survey distribution and analysis. A mixed logit model was used for ranking nurse practitioners' preferred job characteristics and the extent to which they would need to be compensated. RESULTS On average nurse practitioners were 47.4 years of age; the majority were female (90 %), white (75.3 %), and educated at the master's level (88.7 %). Participants did not value teams that were not very cohesive (β = -1.50); administration that was not very responsive and supportive (β = -1.04); being supervised by a physician (β = -0.58); not having their own panel of patients (β = -0.42); and not billing under their own National Provider Identifier (β = -0.18). Participants would need an increase in annual income of USD$21,780 for practicing in a not very cohesive team; USD$15,280 for practicing with a not very responsive administration; and USD$21,450 for being supervised by a physician. CONCLUSIONS A cohesive, responsive, and supportive working environment and being able to practice independently are important characteristics for nurse practitioners when choosing a job. Healthcare managers should provide a workplace culture that reflects these preferred job characteristics to attract and retain nurse practitioners. Policymakers should consider reforming the scope of practice legislation to promote the independent practice of nurse practitioners.
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Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA,Corresponding author at: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30324, USA
| | - John R. Howell
- Department of Marketing and Global Supply Chain, Brigham Young University, Provo, UT, USA
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Li Y, Hockenberry JM, Chen J, Cimiotti JP. Correction: Registered nurses: can our supply meet the demand during a disaster? BMC Nurs 2022; 21:310. [DOI: 10.1186/s12912-022-01079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
BACKGROUND AND OBJECTIVES While root cause analysis (RCA) is used to analyze medical errors with a systems approach, evidence demonstrating its effectiveness in reducing patient harm remains sparse. The heterogeneity of the RCA methodology at different health care organizations has posed challenges to studying its value. The Department of Veterans Affairs (VA) has an established and standardized RCA approach, making it an ideal context to study RCA's impact. This review assessed whether implemented interventions recommended by RCAs were effective in mitigating preventable adverse events at the VA. METHODS PubMed, Web of Science, CINAHL and Business Source were searched for studies on RCAs performed at the VA that evaluated effectiveness of interventions and were published between 2010 and 2020. The Appraisal Tool for Cross-sectional Studies (AXIS) was used to assess bias of bias. RESULTS The majority of studies eliminated during our eligibility process reported on RCAs without attention to their specific impact on patient safety. Ten retrospective studies met inclusion criteria and were part of the final review. Studies were grouped into adverse events related to incorrect surgical/invasive procedures, suicides, falls with injury, and all-cause adverse events. Six studies reported on effectiveness by demonstrating quantitative changes in adverse events over time or by location following a specific intervention. Four studies reported on the effectiveness of implemented interventions using a facility-based rating of "much better" or "better." CONCLUSIONS Of the studies included in this review, all reported improvements following interventions implemented after RCAs, but with variability in study definitions and methodology to assess effectiveness. Increased reporting of outcomes following RCAs, with an emphasis on quantitative patient-related outcome measures, is needed to demonstrate the impact and value of the RCA.
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Affiliation(s)
- Freny Shah
- Department of Education, Atlanta VA Health Care System, Decatur, Georgia (Drs Shah and Falconer); Departments of Medicine (Dr Shah) and Surgery (Dr Falconer), Emory University School of Medicine, Atlanta, Georgia; and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Cimiotti)
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Muirhead L, Cimiotti JP, Hayes R, Haynes-Ferere A, Martyn K, Owen M, McCauley L. Diversity in nursing and challenges with the NCLEX-RN. Nurs Outlook 2022; 70:762-771. [PMID: 35933180 DOI: 10.1016/j.outlook.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
High-stakes, standardized testing has historically impeded education/career attainment for members of underrepresented minority groups and people needing testing accommodations. This study was to understand how high-stakes, standardized testing, particularly the NCLEX-RN, impacts diversity, equity, and inclusion (DEI) in nursing. This study explored the history, context, perspectives surrounding standardized testing, with a focus on the NCLEX-RN. The authors consider content, form, and delivery of testing, including accommodations. They identify available data and data collection gaps relevant to DEI and the NCLEX-RN. No nursing organization published the national data necessary to evaluate/refine the NCLEX-RN from a DEI perspective. Preliminary nursing studies and data from other professions indicated disparities in testing outcomes. Nursing must determine if prospective nurses are experiencing disparities in testing outcomes. The authors highlight opportunities to advance DEI through improved data collection, reformed licensure processes, and the reframing of standardized testing as one of many tools to determine competency.
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Affiliation(s)
- Lisa Muirhead
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | | | - Rose Hayes
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
| | | | - Kristy Martyn
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Melissa Owen
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Linda McCauley
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
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Cimiotti JP, Becker ER, Li Y, Sloane DM, Fridkin SK, West AB, Aiken LH. Association of Registered Nurse Staffing With Mortality Risk of Medicare Beneficiaries Hospitalized With Sepsis. JAMA Health Forum 2022; 3:e221173. [PMID: 35977257 PMCID: PMC9142874 DOI: 10.1001/jamahealthforum.2022.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022] Open
Abstract
Question Is registered nurse workload associated with mortality among Medicare beneficiaries who are admitted to an acute care hospital with a diagnosis of sepsis? Findings In this cross-sectional study of 1958 acute care hospitals and 702 140 Medicare beneficiaries with a diagnosis of sepsis, an increase in registered nurse hours per patient day was associated with a 3% decrease in 60-day mortality in these older adults, a finding that was statistically significant. Meaning The study results suggest that the hours of care provided by registered nurses is likely associated with the outcomes of patients with a diagnosis of sepsis. Importance Sepsis is a major physiologic response to infection that if not managed properly can lead to multiorgan failure and death. The US Centers for Medicare & Medicaid Services (CMS) requires that hospitals collect data on core sepsis measure Severe Sepsis and Septic Shock Management Bundle (SEP-1) in an effort to promote the early recognition and treatment of sepsis. Despite implementation of the SEP-1 measure, sepsis-related mortality continues to challenge acute care hospitals nationwide. Objective To determine if registered nurse workload was associated with mortality in Medicare beneficiaries admitted to an acute care hospital with sepsis. Design, Setting, and Participants This cross-sectional study used 2018 data from the American Hospital Association Annual Survey, CMS Hospital Compare, and Medicare claims on Medicare beneficiaries age 65 to 99 years with a primary diagnosis of sepsis that was present on admission to 1 of 1958 nonfederal, general acute care hospitals that had data on CMS SEP-1 scores and registered nurse workload (indicated by registered nurse hours per patient day [HPPD]). Patients with sepsis were identified based on 29 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Data were analyzed throughout 2021. Exposures SEP-1 score and registered nurse staffing. Main Outcomes and Measures The patient outcome of interest was mortality within 60 days of admission. Hospital characteristics included number of beds, ownership, teaching status, technology status, rurality, and region. Patient characteristics included age, sex, transfer status, intensive care unit admission, palliative care, do-not-resuscitate order, and a series of 29 comorbid diseases based on the Elixhauser Comorbidity Index. Results In total, 702 140 Medicare beneficiaries (mean [SD] age, 78.2 [8.7] years; 360 804 women [51%]) had a diagnosis of sepsis. The mean SEP-1 score was 56.1, and registered nurse HPPD was 6.2. In a multivariable regression model, each additional registered nurse HPPD was associated with a 3% decrease in the odds of 60-day mortality (odds ratio, 0.97; 95% CI 0.96-0.99) controlling for SEP-1 score and hospital and patient characteristics. Conclusions and Relevance The results of this cross-sectional study suggest that hospitals that provide more registered nurse hours of care could likely improve SEP-1 bundle compliance and decrease the likelihood of mortality in Medicare beneficiaries with sepsis.
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Affiliation(s)
- Jeannie P. Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Edmund R. Becker
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | | - Scott K. Fridkin
- Rollins School of Public Health, Emory University, Atlanta, Georgia
- School of Medicine, Emory University, Atlanta, Georgia
| | - Anna Beth West
- School of Medicine, Emory University, Atlanta, Georgia
- VA Quality Scholars Program, Atlanta VA Health Care System, Atlanta, Georgia
| | - Linda H. Aiken
- School of Nursing, University of Pennsylvania, Philadelphia
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Dierkes AM, Aiken LH, Sloane DM, Cimiotti JP, Riman KA, McHugh MD. Hospital nurse staffing and sepsis protocol compliance and outcomes among patients with sepsis in the USA: a multistate cross-sectional analysis. BMJ Open 2022; 12:e056802. [PMID: 35318235 PMCID: PMC8943766 DOI: 10.1136/bmjopen-2021-056802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Sepsis is a serious inflammatory response to infection with a high death rate. Timely and effective treatment may improve sepsis outcomes resulting in mandatory sepsis care protocol adherence reporting. How the impact of patient-to-nurse staffing compares to sepsis protocol compliance and patient outcomes is not well understood. This study aimed to determine the association between hospital sepsis protocol compliance, patient-to-nurse staffing ratios and patient outcomes. DESIGN A cross-sectional study examining hospital nurse staffing, sepsis protocol compliance and sepsis patient outcomes, using linked data from nurse (2015-2016, 2020) and hospital (2017) surveys, and Centers for Medicare and Medicaid Services Hospital Compare (2017) and corresponding MedPAR patient claims. SETTING 537 hospitals across six US states (California, Florida, Pennsylvania, New York, Illinois and New Jersey). PARTICIPANTS 252 699 Medicare inpatients with sepsis present on admission. MEASURES The explanatory variables are nurse staffing and SEP-1 compliance. Outcomes are mortality (within 30 and 60 days of index admission), readmissions (within 7, 30, and 60 days of discharge), admission to the intensive care unit (ICU) and lengths of stay (LOS). RESULTS Sepsis protocol compliance and nurse staffing vary widely across hospitals. Each additional patient per nurse was associated with increased odds of 30-day and 60-day mortality (9% (OR 1.09, 95% CI 1.05 to 1.13) and 10% (1.10, 95% CI 1.07 to 1.14)), 7-day, 30-day and 60-day readmission (8% (OR 1.08, 95% CI 1.05 to 1.11, p<0.001), 7% (OR 1.07, 95% CI 1.05 to 1.10, p<0.001), 7% (OR 1.07, 95% CI 1.05 to 1.10, p<0.001)), ICU admission (12% (OR 1.12, 95% CI 1.03 to 1.22, p=0.007)) and increased relative risk of longer LOS (10% (OR 1.10, 95% CI 1.08 to 1.12, p<0.001)). Each 10% increase in sepsis protocol compliance was associated with shorter LOS (2% ([OR 0.98, 95% CI 0.97 to 0.99, p<0.001)) only. CONCLUSIONS Outcomes are more strongly associated with improved nurse staffing than with increased compliance with sepsis protocols.
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Affiliation(s)
- Andrew M Dierkes
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Jeannie P Cimiotti
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Kathryn A Riman
- Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Li Y, Cimiotti JP, Evans KA, Clevenger CK. The characteristics and practice proficiency of nurse practitioners who care for older adults. Geriatr Nurs 2022; 46:213-217. [PMID: 35241307 DOI: 10.1016/j.gerinurse.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.
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Affiliation(s)
- Yin Li
- Assistant Professor of Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA
| | - Jeannie P Cimiotti
- Associate Professor of Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 358, Atlanta, GA 30322-4027, USA
| | | | - Carolyn K Clevenger
- Associate Dean for Transformative Clinical Practice, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
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Li Y, Hockenberry JM, Chen J, Cimiotti JP. Registered nurses: can our supply meet the demand during a disaster? BMC Nurs 2022; 21:7. [PMID: 34983516 PMCID: PMC8724595 DOI: 10.1186/s12912-021-00794-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Death and destructions are often reported during natural disasters; yet little is known about how hospitals operate during disasters and if there are sufficient resources available for hospitals to provide ongoing care during these catastrophic events. The purpose of this study was to determine if the State of New Jersey had a supply of registered nurses (RNs) that was sufficient to meet the needs of hospitalized patients during a natural disaster - Hurricane Sandy. METHODS Secondary data were used to forecast the demand and supply of New Jersey RNs during Hurricane Sandy. Data sources from November 2011 and 2012 included the State Inpatient Databases (SID), American Hospital Association (AHA) Annual Survey on hospital characteristics and staffing data from New Jersey Department of Health. Three models were used to estimate the RN shortage for each hospital, which was the difference between the demand and supply of RN full-time equivalents. RESULTS Data were available on 66 New Jersey hospitals, more than half of which experienced a shortage of RNs during Hurricane Sandy. For hospitals with a RN shortage in ICUs, a 20% increase in observed RN supply was needed to meet the demand; and a 10% increase in observed RN supply was necessary to meet the demand for hospitals with a RN shortage in non-ICUs. CONCLUSION Findings from this study suggest that many hospitals in New Jersey had a shortage of RNs during Hurricane Sandy. Efforts are needed to improve the availability of nurse resources during a natural disaster.
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Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, Georgia, 30322-4027, USA.
| | - Jason M Hockenberry
- Department of Health Policy and Management, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520-0834, USA
| | | | - Jeannie P Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, Georgia, 30322-4027, USA
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Li Y, Greenwood L, Eichelberger LW, Marion L, Cleghorn J, Wheeler R, Cimiotti JP. State and national data on the Georgia nursing workforce. Nurs Outlook 2021; 70:47-54. [PMID: 34620493 DOI: 10.1016/j.outlook.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/21/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The enduring absence of robust nursing workforce data creates gaps to support evidence-based workforce planning and policy development. PURPOSE The purpose of this study was to examine Georgia nursing workforce data available through state and national agencies to determine if significance differences exist among data sources. METHODS A cross-sectional, descriptive analysis of 2017 Georgia nursing workforce data was used to examine and compare workforce characteristics available from five data sources. The advantages and limitations of each data source were reviewed. FINDINGS Significant differences were noted in the quality and quantity of data collected on the Georgia nursing workforce as reported by state and national agencies. None of the datasets include in our analysis had comprehensive and timely data on the Georgia nursing workforce. DISCUSSION Nursing workforce stakeholders must work collaboratively to require and implement a comprehensive re-licensure survey. It is only though a standardized national minimum dataset that we can ensure an adequate nursing workforce.
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Affiliation(s)
- Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University Atlanta, GA
| | | | | | - Lucy Marion
- Augusta University College of Nursing, Augusta, GA
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Li Y, Cimiotti JP. Nurse Staffing and Patient Outcomes During a Natural Disaster. Journal of Nursing Regulation 2021. [DOI: 10.1016/s2155-8256(21)00114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown. OBJECTIVE The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing. RESEARCH DESIGN This was a 2015-2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1-2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)]. SUBJECTS RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals. MEASURES Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses. RESULTS After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67-0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86-0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88-0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%-7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs. CONCLUSIONS Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.
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Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
| | - Heather M Brom
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Villanova University M. Louise Fitzpatrick College of Nursing, Villanova
| | - Barbara A Todd
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Hilary Barnes
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- School of Nursing, University of Delaware, Newark, DE
| | - Jeannie P Cimiotti
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Regina S Cunningham
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, The University of Pennsylvania School of Nursing
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Lasater KB, Sloane DM, McHugh MD, Cimiotti JP, Riman KA, Martin B, Alexander M, Aiken LH. Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes. Am J Infect Control 2021; 49:868-873. [PMID: 33309843 DOI: 10.1016/j.ajic.2020.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite nurses' responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. METHODS Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients' odds of in-hospital and 60-day mortality, readmission, and length of stay. Logistic regression is used to estimate mortality and readmission, while zero-truncated negative binomial models are used for length of stay. RESULTS Each additional patient per nurse is associated with 12% higher odds of in-hospital mortality, 7% higher odds of 60-day mortality, 7% higher odds of 60-day readmission, and longer lengths of stay, even after accounting for patient and hospital covariates including hospital adherence to SEP-1 bundles. Adherence to SEP-1 bundles is associated with lower in-hospital mortality and shorter lengths of stay; however, the effects are markedly smaller than those observed for staffing. DISCUSSION Improving hospital nurse staffing over and above implementing sepsis bundles holds promise for significant improvements in sepsis patient outcomes.
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Affiliation(s)
- Karen B Lasater
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Kathryn A Riman
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Brendan Martin
- National Council of State Boards of Nursing, Chicago, IL
| | | | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Abstract
IMPORTANCE Clinician burnout is a major risk to the health of the US. Nurses make up most of the health care workforce, and estimating nursing burnout and associated factors is vital for addressing the causes of burnout. OBJECTIVE To measure rates of nurse burnout and examine factors associated with leaving or considering leaving employment owing to burnout. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis used cross-sectional survey data collected from April 30 to October 12, 2018, in the National Sample Survey of Registered Nurses in the US. All nurses who responded were included (N = 50 273). Data were analyzed from June 5 to October 1, 2020. EXPOSURES Age, sex, race and ethnicity categorized by self-reported survey question, household income, and geographic region. Data were stratified by workplace setting, hours worked, and dominant function (direct patient care, other function, no dominant function) at work. MAIN OUTCOMES AND MEASURES The primary outcomes were the likelihood of leaving employment in the last year owing to burnout or considering leaving employment owing to burnout. RESULTS The weighted sample of 50 273 respondents (representing 3 957 661 nurses nationally) was predominantly female (90.4%) and White (80.7%); the mean (SD) age was 48.7 (0.04) years. Among nurses who reported leaving their job in 2017 (n = 418 769), 31.5% reported burnout as a reason, with lower proportions of nurses reporting burnout in the West (16.6%) and higher proportions in the Southeast (30.0%). Compared with working less than 20 h/wk, nurses who worked more than 40 h/wk had a higher likelihood identifying burnout as a reason they left their job (odds ratio, 3.28; 95% CI, 1.61-6.67). Respondents who reported leaving or considering leaving their job owing to burnout reported a stressful work environment (68.6% and 59.5%, respectively) and inadequate staffing (63.0% and 60.9%, respectively). CONCLUSIONS AND RELEVANCE These findings suggest that burnout is a significant problem among US nurses who leave their job or consider leaving their job. Health systems should focus on implementing known strategies to alleviate burnout, including adequate nurse staffing and limiting the number of hours worked per shift.
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Affiliation(s)
- Megha K. Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Nikhila Gandrakota
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Neena Ghose
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Miranda Moore
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mohammed K. Ali
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Sheehan TO, Davis NW, Peach BC, Ansell M, Cimiotti JP, Guo Y, Lynch Kelly D, Yoon SL, Horgas AL. Hospital Characteristics and Mortality in Aneurysmal Subarachnoid Hemorrhage. J Neurosci Nurs 2021; 53:2-4. [PMID: 32925560 DOI: 10.1097/jnn.0000000000000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peach BC, Li Y, Cimiotti JP. Urosepsis in Older Adults: Epidemiologic Trends in Florida. J Aging Soc Policy 2021; 34:626-640. [PMID: 33413039 DOI: 10.1080/08959420.2020.1851432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence and geographic distribution of urosepsis, a life-threatening condition in older adults, is not well understood. The Florida State Inpatient Databases (2012-2014) showed an increase in the incidence of community-acquired urosepsis (5.37 to 6.16 per 1000), particularly among Hispanic older adults residing in low socioeconomic, urban areas with large numbers of nursing homes. These findings suggest a state policy is needed to address community-based preventative care and education for early detection of urosepsis in low-income urban areas. It is important for local health departments to partner with nursing homes to address disparities in care that disproportionally impact Hispanics.
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Affiliation(s)
- Brian C Peach
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jeannie P Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Landerfelt PE, Lewis A, Li Y, Cimiotti JP. Nursing leadership and the reduction of catheter-associated urinary tract infection. Am J Infect Control 2020; 48:1546-1548. [PMID: 32682017 DOI: 10.1016/j.ajic.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
The prevention of infections continues to be a challenge for many hospitals. We examined specific features of nursing leadership and found improvements in leadership were associated with a decrease in catheter-associated urinary tract infection. Infection prevention efforts in acute care hospitals should focus on nurse leaders and their ability to provide the support necessary to improve care delivery-support that could be instrumental in the reduction and the elimination of catheter-associated urinary tract infection.
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Lucero RJ, Romero S, Fieo R, Cortes Y, Cimiotti JP, Poghosyan L. Language equivalence of the modified falls efficacy scale (MFES) among English- and Spanish-speaking older adults: Rasch analysis. BMC Geriatr 2020; 20:286. [PMID: 32787777 PMCID: PMC7422612 DOI: 10.1186/s12877-020-01627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/22/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To investigate item-level measurement properties of the Modified Falls Efficacy (MFES) Scale among English- and Spanish-speaking urban-dwelling older adults as a means to evaluate language equivalence of the tool. METHODS Secondary analysis of survey data from 170 English (n = 83) and Spanish (n = 87) speaking older adults who reported to the emergency department of a quaternary medical center in New York City between February 2010 and August 2011. The Rasch rating scale model was used to investigate item statistics and ordering of items, item and person reliability, and model performance of the Modified Falls Efficacy Scale. RESULTS The Modified Falls Efficacy Scale, for English- and Spanish-speakers, demonstrated acceptable fit to the Rasch model of a unidimensional measure. While the range of the construct is more limited for the Spanish group, the interval between tasks are much closer, reflecting little to no construct under-representation. CONCLUSION There is rationale for continued testing of a unidemsional English- and Spanish-MFES among urban community-dwelling older adults. Large-scale international studies linking the unidemsional MFES to patient outcomes will support the validity of this tool for research and practice.
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Affiliation(s)
- Robert J Lucero
- Department of Family, Community, and Health System Science, Center for Latin American Studies, College of Nursing, University of Florida, 1225 Center Drive, Gainesville, Florida, 32610, USA.
| | - Sergio Romero
- North Florida/South Georgia Veterans Health System, Center of Innovation on Disability and Rehabilitation Research, 300 E. University Avenue, Gainesville, FL, 32601, USA
| | - Robert Fieo
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, Florida, NY, 32610, USA
| | - Yamnia Cortes
- The University of North Carolina at Chapel Hill, School of Nursing, S. Columbia Street, Chapel Hill, NC, 27599, USA
| | - Jeannie P Cimiotti
- Department of Family, Community, and Health Systems Science, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, Atlanta, GA, 30322, USA
| | - Lusine Poghosyan
- Columbia University, School of Nursing, Center for Health Policy, 560 W. 168th Street, New York, NY, 10032, USA
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Dunbar SB, Cimiotti JP, Reilly CM. A Tribute to Our Nurses on the Front Lines of Care. Am J Crit Care 2020; 29:318-319. [PMID: 32409821 DOI: 10.4037/ajcc2020760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sandra B. Dunbar
- About the Authors: Sandra B. Dunbar is senior associate dean for academic advancement and Charles Howard Candler Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Jeannie P. Cimiotti
- Jeannie P. Cimiotti is an associate professor, Nell Hodgson Woodruff School of Nursing, Emory University
| | - Carolyn M. Reilly
- Carolyn M. Reilly is an associate professor, Nell Hodgson Woodruff School of Nursing, Emory University
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Abstract
Introduction The current shortage of physicians in the United States has potential to dramatically limit access to healthcare. Nurse practitioners (NPs) can provide a cost-effective solution to the shortage, yet few states allow NPs to practice independently. Purpose The purpose of this study was to provide an up-to-date description of the NP workforce and to identify the professional and organizational factors associated with NP care quality. Methods Cross-sectional survey data from a sample of NPs actively employed in four states with reduced or restricted practice (California, Florida, New Jersey, and Pennsylvania) was used. NPs were categorized into acute and primary care. Regression models were fit to estimate the odds of three measures of care quality: overall quality of patient care, NP confidence that patients and their caregivers can manage their care at home, and whether NPs would recommend their practice facility to family and friends. Results Receiving support from administrative staff and physicians was associated with an increase in the three measures of quality. The greatest effects were seen in primary care settings. Conclusion It is imperative that legislators and healthcare administrators implement policies that provide NPs with an environment that supports clinical practice and enhances care delivery.
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Affiliation(s)
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University
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Aiken LH, Sloane DM, Barnes H, Cimiotti JP, Jarrín OF, McHugh MD. Nurses' And Patients' Appraisals Show Patient Safety In Hospitals Remains A Concern. Health Aff (Millwood) 2019; 37:1744-1751. [PMID: 30395515 DOI: 10.1377/hlthaff.2018.0711] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Institute of Medicine concluded in To Err Is Human in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated with greater progress in patient safety. Survey data from thousands of nurses and patients showed that patient safety remains a serious concern. Only 21 percent of study hospitals showed sizable improvements (of more than 10 percent) in work environment scores, while 7 percent had worse scores. For hospitals in which clinical care environments improved, patients and nurses reported improvements in patient safety indicators. These included increases in percentages of patients rating their hospital favorably (a change of 11 percent) and stating that they would definitely recommend the hospital (8 percent) and in percentages of nurses reporting excellent quality of care (15 percent) and giving the hospital a favorable grade on patient safety (15 percent). Where work environments deteriorated, fewer nurses (-19 percent) gave a favorable grade on patient safety. Failure to improve hospital work environments may be hampering progress on patient safety.
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Affiliation(s)
- Linda H Aiken
- Linda H. Aiken ( ) is the Claire M. Fagin Leadership Professor of Nursing, professor of sociology, director of the Center for Health Outcomes and Policy Research, and a senior fellow at the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia
| | - Douglas M Sloane
- Douglas M. Sloane is an adjunct professor at the Center for Health Outcomes and Policy Research and the School of Nursing, University of Pennsylvania
| | - Hilary Barnes
- Hilary Barnes is an assistant professor in the School of Nursing, University of Delaware, in Newark
| | - Jeannie P Cimiotti
- Jeannie P. Cimiotti is an associate professor in the School of Nursing, Emory University, in Atlanta, Georgia
| | - Olga F Jarrín
- Olga F. Jarrín is an assistant professor in the School of Nursing, Institute for Health, Health Care Policy, and Aging Research at Rutgers, the State University of New Jersey, in New Brunswick
| | - Matthew D McHugh
- Matthew D. McHugh is a professor of nursing, the Independence Chair for Nursing Education, associate director of the Center for Health Outcomes and Policy Research, and a senior fellow at the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
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Abstract
BACKGROUND AND PURPOSE To examine computational measures of job-related burnout to determine the best computation to estimate job satisfaction and intent to leave in Brazilian nursing professionals. METHODS Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used assess burnout in 452 hospital-based nursing professionals. Adjusted logistic regression models were fit using different computations of burnout to estimate outcomes of interest. RESULTS Total mean score of burnout subscales was the best estimate of job satisfaction (Cox-Snell R2 = 0.312; Nagelkerke R2 = 0.450) and intent to leave (Cox-Snell R2 = 0.156; Nagelkerke R2 = 0.300), as was high emotional exhaustion (Cox-Snell R2 = 0.219; Nagelkerke R2 = 0.316). CONCLUSION We have provided evidence that different computations of data from the Portuguese (Brazil) MBI-HSS can be used in to estimate the effect of job-related burnout on nurse outcomes.
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Affiliation(s)
| | | | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Abstract
Job-related burnout has been reported by intensive care nurses worldwide; this study was performed to examine burnout in intensive care unit bedside nurses and nurse technicians in Brazil. A cross-sectional survey that included the Practice Environment Scale and the Maslach Burnout Inventory was completed by 209 nurses and nurse technicians working in 4 Brazilian intensive care units in 3 teaching hospitals. Compared with nurse technicians, nurses reported higher levels of emotional exhaustion and depersonalization, and a lower level of personal accomplishment. A 1-unit increase in the quality of nurse practice environment was associated with a decrease in high levels of emotional exhaustion and low levels of personal accomplishment. Each additional patient added to a nurse’s workload was associated with an increase in high emotional exhaustion and low personal accomplishment. Approximately one-third of Brazilian nurses working in intensive care units report job-related burnout; the practice environment and staffing appear to be contributing factors.
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Affiliation(s)
- Francino Azevedo Filho
- Francino Azevedo Filho is Assistant Professor, State University of Goias, Brazil. Maria Cristina Soares Rodrigues is Associate Professor and Associate Dean, Faculty of Health Sciences, University of Brasília, Brazil. Jeannie P. Cimiotti is Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322
| | - Maria Cristina Soares Rodrigues
- Francino Azevedo Filho is Assistant Professor, State University of Goias, Brazil. Maria Cristina Soares Rodrigues is Associate Professor and Associate Dean, Faculty of Health Sciences, University of Brasília, Brazil. Jeannie P. Cimiotti is Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322
| | - Jeannie P. Cimiotti
- Francino Azevedo Filho is Assistant Professor, State University of Goias, Brazil. Maria Cristina Soares Rodrigues is Associate Professor and Associate Dean, Faculty of Health Sciences, University of Brasília, Brazil. Jeannie P. Cimiotti is Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322
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Mazzella Ebstein AM, Sanzero Eller L, Tan KS, Cherniss C, Ruggiero JS, Cimiotti JP. The relationships between coping, occupational stress, and emotional intelligence in newly hired oncology nurses. Psychooncology 2018; 28:278-283. [PMID: 30396231 DOI: 10.1002/pon.4937] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/08/2018] [Accepted: 10/26/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Associations between the varying levels of emotional intelligence in newly hired oncology nurses and their responses to stress and coping were examined. The secondary aim was to analyze whether emotional intelligence could moderate their choice of problem-focused or emotion-focused coping strategies. METHODS Newly hired nurses (n = 114) were recruited from a national cancer institute. Data were collected through surveys using the Ways of Coping Questionnaire, the Nursing Stress Scale, and the Emotional Quotient Inventory between the eighth and twelfth weeks post-hire date. Descriptive and bivariate statistical analyses were conducted on all variables. Regression models determined whether emotional intelligence moderated the choice of coping strategies. RESULTS Emotional intelligence had a mean value of M = 105.24, SD = 13.02, and occupational stress scores were M = 65.57, SD = 15.68. Significant negative correlations were found for occupational stress and problem-focused coping (r = -.189, P = .022), emotional intelligence and emotion-focused coping (r = -.340, P = .000), and emotional intelligence and occupational stress (r = -.428, P < 0.001). Positive correlations were noted between occupational stress and emotion-focused coping (r = .189, P = .022) and emotional intelligence and problem-focused coping (r = .340, P = .000). Emotional intelligence did not predict the choice of coping strategies. CONCLUSIONS Although emotional intelligence did not moderate coping strategies in newly hired nurses, using problem focused coping to address occupational stress during the initial employment period may be a protective factor for coping with stress in the oncology workplace.
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Affiliation(s)
| | | | - Kay See Tan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cary Cherniss
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Lucero RJ, Lindberg DS, Fehlberg EA, Bjarnadottir RI, Li Y, Cimiotti JP, Crane M, Prosperi M. A data-driven and practice-based approach to identify risk factors associated with hospital-acquired falls: Applying manual and semi- and fully-automated methods. Int J Med Inform 2018; 122:63-69. [PMID: 30623785 DOI: 10.1016/j.ijmedinf.2018.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/18/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Electronic health record (EHR) data provides opportunities for new approaches to identify risk factors associated with iatrogenic conditions, such as hospital-acquired falls. There is a critical need to validate and translate prediction models that support fall prevention clinical decision-making in hospitals. The purpose of this study was to explore a combined data-driven and practice-based approach to identify risk factors associated with falls. PROCEDURES We conducted an observational case-control study of EHR data from January 1, 2013 to October 31, 2013 from 14 medical-surgical units of a tertiary referral teaching hospital. Patients aged 21 or older admitted to medical surgical units were included in the study. Manual and semi- and fully-automated methods were used to identify fall risk factors across four prediction models. Sensitivity, specificity, and the Area under the Receiver Operating Characteristic (AUROC) curve were calculated for all models using 10-fold cross validation. FINDINGS We confirmed the significance of a set of valid fall risk factors (i.e., age, gender, fall risk assessment, history of falling, mental status, mobility, and confusion) and identified set of new risk factors (i.e., # of fall risk increasing drugs, hemoglobin level, physical therapy initiation, Charlson Comorbity Index, nurse skill mix, and registered nurse staffing ratio) based on the most precise prediction approach, namely stepwise regression. CONCLUSIONS The use of semi- and fully-automated approaches with expert clinical knowledge over expert or data-driven only approaches can significantly improve identifying patient, clinical, and organizational risk factors of iatrogenic conditions, including hospital-acquired falls.
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Affiliation(s)
- Robert James Lucero
- University of Florida, College of Nursing, United States; University of Florida, Center for Latin American Studies, United States; University of Florida, Florida Blue Center for Health Care Quality, United States; University of Florida, Informatics Institute, United states.
| | - David S Lindberg
- University of Florida, College of Liberal Arts and Sciences, United States
| | | | - Ragnhildur I Bjarnadottir
- University of Florida, College of Nursing, United States; University of Florida, Informatics Institute, United states
| | - Yin Li
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
| | - Jeannie P Cimiotti
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
| | - Marsha Crane
- UF Health-Shands Hospital, Gainesville, FL, United States
| | - Mattia Prosperi
- University of Florida, College of Public Health and Health Professions, United States; University of Florida, College of Medicine, United States
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Dutra HS, Cimiotti JP, Guirardello EDB. Nurse work environment and job-related outcomes in Brazilian hospitals. Appl Nurs Res 2018; 41:68-72. [DOI: 10.1016/j.apnr.2018.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/28/2022]
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Abstract
Resumo Objetivo Analisar o ambiente da prática de enfermagem em unidades de terapia intensiva. Métodos Estudo descritivo, de abordagem quantitativa, realizado com 209 profissionais de enfermagem de três hospitais de ensino brasileiros. O ambiente da prática de enfermagem foi avaliado através da Practice Environment Scale. Os dados foram analisados descritivamente, assumindo nível de significância de 5% (p<0,05). O coeficiente Alfa de Cronbach foi utilizado para examinar a consistência interna dos construtos. Resultados Os profissionais de enfermagem consideraram desfavoráveis quatro das cinco dimensões do ambiente da prática profissional: participação dos enfermeiros na discussão dos assuntos hospitalares; fundamentos de enfermagem voltados para a qualidade do cuidado, habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem; e adequação da equipe e de recursos. Apenas a dimensão relações colegiais entre profissionais de enfermagem e médicos apresentou avaliação positiva. Enfermeiros reconheceram mais fortemente atributos desfavoráveis no ambiente de prática do que técnicos de enfermagem. Conclusão O ambiente mostrou-se desfavorável para a prática dos profissionais de enfermagem. Esforços são necessários para tornar o ambiente de prática mais atrativo aos profissionais de enfermagem, e assim estimular melhorias na qualidade e na segurança da assistência prestada.
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Olds DM, Aiken LH, Cimiotti JP, Lake ET. Association of nurse work environment and safety climate on patient mortality: A cross-sectional study. Int J Nurs Stud 2017; 74:155-161. [PMID: 28709013 DOI: 10.1016/j.ijnurstu.2017.06.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/09/2017] [Accepted: 06/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are two largely distinct research literatures on the association of the nurse work environment and the safety climate on patient outcomes. OBJECTIVE To determine whether hospital safety climate and work environment make comparable or distinct contributions to patient mortality. DESIGN Cross-sectional secondary analysis of linked datasets of Registered Nurse survey responses, adult acute care discharge records, and hospital characteristics. SETTING Acute care hospitals in California, Florida, New Jersey, and Pennsylvania. PARTICIPANTS The sample included 600 hospitals linked to 27,009 nurse survey respondents and 852,974 surgical patients. METHODS Nurse survey data included assessments of the nurse work environment and hospital safety climate. The outcome of interest was in-hospital mortality. Data analyses included descriptive statistics and multivariate random intercept logistic regression. RESULTS In a fully adjusted model, a one standard deviation increase in work environment score was associated with an 8.1% decrease in the odds of mortality (OR 0.919, p<0.001). A one-standard deviation increase in safety climate score was similarly associated with a 7.7% decrease in the odds of mortality (OR 0.923, p<0.001). However, when work environment and safety climate were modeled together, the effect of the work environment remained significant, while safety climate became a non-significant predictor of mortality odds (OR 0.940, p=0.035 vs. OR 0.971, p=0.316). CONCLUSIONS We found that safety climate perception is not predictive of patient mortality beyond the effect of the nurse work environment. To advance hospital safety and quality and improve patient outcomes, organizational interventions should be directed toward improving nurse work environments.
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Affiliation(s)
- Danielle M Olds
- University of Kansas Medical Center, School of Nursing, 3901 Rainbow Blvd., Mail Stop 4043, Kansas City, KS 66160 913-588-0426, United States.
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, The Claire M. Fagin Leadership Professor of Nursing, Professor of Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
| | - Jeannie P Cimiotti
- Florida Blue Center for Health Care Quality, Associate Professor and Dorothy M. Smith Endowed Chair, University of Florida, Gainesville, FL, United States.
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, Jessie M. Scott Endowed Term Associate Professor in Nursing and Health Policy, Associate Professor of Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, United States.
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Spetz J, Cimiotti JP, Brunell ML. Improving collection and use of interprofessional health workforce data: Progress and peril. Nurs Outlook 2016; 64:377-84. [DOI: 10.1016/j.outlook.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To identify factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections at the level of the hospital organization. DATA SOURCES Data from all 173 acute trusts in the English National Health Service (NHS). STUDY DESIGN A longitudinal study based on trust-level panel data for the 5-year period from April 2004 to March 2009. Fixed effects negative binominal and system generalized method of moment models were used to examine the effect of (i) patient mix characteristics, (ii) resource endowments, and (iii) infection control practices on yearly MRSA counts. DATA COLLECTION Archival and staff survey data from multiple sources, including Public Health England, the English Department of Health, and the Healthcare Commission, were merged to form a balanced panel dataset. PRINCIPAL FINDINGS MRSA infections decrease with increases in general cleaning (-3.52 MRSA incidents per 1 standard deviation increase; 95 percent confidence interval: -6.61 to -0.44), infection control training (-3.29; -5.22 to -1.36), hand hygiene (-2.72; -4.76 to -0.68), and error reporting climate (-2.06; -4.09 to -0.04). CONCLUSIONS Intensified general cleaning, improved hand hygiene, additional infection control training, and a climate conducive to error reporting emerged as the factors most closely associated with trust-level reductions in MRSA infections over time.
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Affiliation(s)
- Torsten Oliver Salge
- Innovation, Strategy and Organization Group (ISO) and TIME Research Area, RWTH Aachen University School of Business and Economics, Aachen, Germany
| | - Antonio Vera
- Department of Organization and Human Resource Management, German Police University, Münster, Germany
| | - David Antons
- Innovation, Strategy and Organization Group (ISO) and TIME Research Area, RWTH Aachen University School of Business and Economics, Aachen, Germany
| | - Jeannie P Cimiotti
- Florida Blue Center forHealth Care Quality, University of Florida College of Nursing, Gainesville, FL
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Peach BC, Garvan GJ, Garvan CS, Cimiotti JP. Risk Factors for Urosepsis in Older Adults: A Systematic Review. Gerontol Geriatr Med 2016; 2:2333721416638980. [PMID: 28138493 PMCID: PMC5119864 DOI: 10.1177/2333721416638980] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 01/20/2023] Open
Abstract
Objective: To identify factors that predispose older adults to urosepsis and urosepsis-related mortality. Method: A systematic search using PubMed and CINAHL databases. Articles that met inclusion criteria were assessed using the Strengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and were scored on a 4-point Likert-type scale. Results: A total of 180 articles were identified, and six met inclusion criteria. The presence of an internal urinary catheter was associated with the development of urosepsis and septic shock. Although a number of factors were examined, functional dependency, number of comorbidities, and low serum albumin were associated with mortality across multiple studies included in this review. Discussion: Little scientific evidence is available on urosepsis, its associated risk factors, and those factors associated with urosepsis-related mortality in older adults. More research is warranted to better understand urosepsis in this vulnerable population in an effort to improve the quality of patient care.
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Hessels A, Flynn L, Cimiotti JP, Bakken S, Gershon R. Impact of Heath Information Technology on the Quality of Patient Care. Online J Nurs Inform 2015; 19:http://www.himss.org/impact-heath-information-technology-quality-patient-care. [PMID: 27570443 PMCID: PMC5001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the relationships among Electronic Health Record (EHR) adoption and adverse outcomes and satisfaction in hospitalized patients. MATERIALS AND METHODS This secondary analysis of cross sectional data was compiled from four sources: (1) State Inpatient Database from the Healthcare Cost Utilization Project; (2) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute; (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) and (4) New Jersey nurse survey data. The final analytic sample consisted of data on 854,258 adult patients discharged from 70 New Jersey hospitals in 2006 and 7,679 nurses working in those same hospitals. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption stage on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. RESULTS Advanced EHR adoption was independently associated with fewer patients with prolonged length of stay and seven-day readmissions. Advanced EHR adoption was not associated with patient satisfaction even when controlling for the strong relationships between better nursing practice environments, particularly staffing and resource adequacy, and missed nursing care and more patients reporting "Top-Box," satisfaction ratings. CONCLUSIONS This innovative study demonstrated that advanced stages of EHR adoption show some promise in improving important patient outcomes of prolonged length of stay and hospital readmissions. Strongly evident by the relationships among better nursing work environments, better quality nursing care, and patient satisfaction is the importance of supporting the fundamentals of quality nursing care as technology is integrated into practice.
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Affiliation(s)
- Amanda Hessels
- Postdoctoral Research Fellow at the Center for Interdisciplinary Research to Prevent Infections (CIRI), Columbia University, School of Nursing and Nurse Scientist at Meridian Health in New Jersey
| | - Linda Flynn
- Professor and the Associate Dean of Academic Programs at the University of Colorado College Of Nursing
| | - Jeannie P Cimiotti
- Associate Professor and the Dorothy M. Smith Endowed Chair at the University of Florida College Of Nursing
| | - Suzanne Bakken
- Alumni Professor of Nursing and Professor of Biomedical Informatics at Columbia University
| | - Robyn Gershon
- Professor of Epidemiology and Biostatistics and Core Faculty in the Philip R. Lee Institute for Health Policy Studies in the School of Medicine at University of California, San Francisco
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Abstract
OBJECTIVES Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. METHODS This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. RESULTS Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. CONCLUSIONS This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.
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Affiliation(s)
| | - Linda Flynn
- College of Nursing, University of Colorado Denver, Colorado, USA
| | | | - Edna Cadmus
- School of Nursing, Rutgers University, New Jersey, USA
| | - Robyn R M Gershon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Johansen ML, de Cordova PB, Duan W, Martinez ME, Cimiotti JP. The Implications of Nurse Resources on Cardiac Care in the Emergency Department. Appl Nurs Res 2015; 28:210-2. [DOI: 10.1016/j.apnr.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/16/2014] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
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Squires A, Finlayson C, Gerchow L, Cimiotti JP, Matthews A, Schwendimann R, Griffiths P, Busse R, Heinen M, Brzostek T, Moreno-Casbas MT, Aiken LH, Sermeus W. Methodological considerations when translating "burnout". ACTA ACUST UNITED AC 2014; 1:59-68. [PMID: 25343131 PMCID: PMC4203660 DOI: 10.1016/j.burn.2014.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.
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Affiliation(s)
- Allison Squires
- College of Nursing, New York University, USA
- Corresponding author at: College of Nursing, New York University, 726 Broadway, 10th Floor, New York, NY 10003, USA. Tel.: +1 212 992 7074. (A. Squires)
| | | | | | - Jeannie P. Cimiotti
- NJ Collaborating Center for Nursing, Rutgers University College of Nursing, USA
| | - Anne Matthews
- School of Nursing & Human Sciences, Dublin City University, Ireland
| | | | - Peter Griffiths
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, England, United Kingdom
| | - Reinhard Busse
- Lehrstuhl Management im Gesundheitswesen/Department of Health Care Management – WHO Collaborating Centre for Health Systems Research and Management, Technische Universitaet Berlin, Germany
| | - Maude Heinen
- IQ Healthcare, Radboud University Medical Center, Nursing Science & Allied Healthcare Division, Nijmegen, The Netherlands
| | - Tomasz Brzostek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Linda H. Aiken
- School of Nursing, University of Pennsylvania, USA
- RN4CAST, Spain
| | - Walter Sermeus
- RN4CAST, Spain
- Program Director Master in Healthcare Management & Nursing Science Centre for Health Services & Nursing Research Catholic University Leuven, Belgium
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Tubbs-Cooley HL, Cimiotti JP, Silber JH, Sloane DM, Aiken LH. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf 2013; 22:735-42. [PMID: 23657609 PMCID: PMC3756461 DOI: 10.1136/bmjqs-2012-001610] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Hospital patient-to-nurse staffing ratios are associated with quality outcomes in adult patient populations but little is known about how these factors affect paediatric care. We examined the relationship between staffing ratios and all-cause readmission (within 14 days, 15–30 days) among children admitted for common medical and surgical conditions. Methods We conducted an observational cross-sectional study of readmissions of children in 225 hospitals by linking nurse surveys, inpatient discharge data and information from the American Hospital Association Annual Survey. Registered Nurses (N=14 194) providing direct patient care in study hospitals (N=225) and children hospitalised for common conditions (N=90 459) were included. Results Each one patient increase in a hospital's average paediatric staffing ratio increased a medical child's odds of readmission within 15–30 days by a factor of 1.11, or by 11% (95% CI 1.02 to 1.20) and a surgical child's likelihood of readmission within 15–30 days by a factor of 1.48, or by 48% (95% CI 1.27 to 1.73). Children treated in hospitals with paediatric staffing ratios of 1 : 4 or less were significantly less likely to be readmitted within 15–30 days. There were no significant effects of nurse staffing ratios on readmissions within 14 days. Discussion Children with common conditions treated in hospitals in which nurses care for fewer patients each are significantly less likely to experience readmission between 15 and 30 days after discharge. Lower patient-to-nurse ratios hold promise for preventing unnecessary hospital readmissions for children through more effective predischarge monitoring of patient conditions, improved discharge preparation and enhanced quality improvement success.
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Abstract
PURPOSE To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. DESIGN AND METHODS Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. FINDINGS Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. CONCLUSIONS Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. CLINICAL RELEVANCE NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.
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Moulton PL, Wiebusch PL, Cleary BL, Brunell ML, Napier DF, Bienemy C, LeVasseur SA, Cimiotti JP. Toward standardization (Part 2): National nursing minimum data sets consensus building and implementation status. Policy Polit Nurs Pract 2012; 13:162-169. [PMID: 23211521 DOI: 10.1177/1527154412466920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
With the passage of the Affordable Care Act and the development of a National Workforce Commission, multiple entities have increased their interest in collecting standardized health care workforce data at the state and national levels. In a tight budget environment, developing data sets which collect the minimum needed information that is necessary for workforce planning and supply/demand projections has become critically needed. This article represents the second of a two part series describing the work that the Forum of State Nursing Workforce Centers has undertaken during the last 3 years toward standardizing nursing workforce data. Part I described the initial steps that informed the development of national nursing workforce minimum data sets. Part II describes the consensus model used to develop the minimum data sets as well as an update on the implementation of the minimum data sets in individual states including challenges and barriers encountered.
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Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control 2012; 40:486-90. [PMID: 22854376 DOI: 10.1016/j.ajic.2012.02.029] [Citation(s) in RCA: 432] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association. METHODS We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care-associated infections. RESULTS There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million. CONCLUSIONS We provide a plausible explanation for the association between nurse staffing and health care-associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities.
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Abstract
Despite the estimated 1.8 million children admitted to hospitals annually, little is known about the quality of care and the adequacy of resources in hospitals that care for acutely ill infants and children. Using survey data from 3,819 pediatric nurses working in 498 hospitals, we found that nursing resources vary significantly across different types of hospitals that care for children. Nurses working in a children's hospital within a hospital, and on a pediatric unit in a general hospital were more likely than nurses in freestanding children's hospitals to report inadequate nursing resources. We also found that inadequate nursing resources were associated with surveillance left undone and missed changes in patients' condition. These findings have implications for the quality and safety of pediatric care.
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McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood) 2011; 30:202-10. [PMID: 21289340 DOI: 10.1377/hlthaff.2010.0100] [Citation(s) in RCA: 452] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, inPhiladelphia, PA, USA.
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Brooks-Carthon JM, Kutney-Lee A, Sloane DM, Cimiotti JP, Aiken LH. Quality of care and patient satisfaction in hospitals with high concentrations of black patients. J Nurs Scholarsh 2011; 43:301-10. [PMID: 21884376 DOI: 10.1111/j.1547-5069.2011.01403.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To examine the influence of nursing-specifically nurse staffing and the nurse work environment-on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. DESIGN Cross-sectional secondary analysis of 2006-2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care-associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. RESULTS Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients' readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. CONCLUSIONS This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients. CLINICAL RELEVANCE Consideration of nursing factors, in addition to other important hospital characteristics, is critical to understanding and improving quality of care and patient satisfaction in minority-serving hospitals.
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