The Nursing Workforce in an Era of Health Care Reform

RAND, Boston, USA.
New England Journal of Medicine (Impact Factor: 54.42). 04/2013; 368(16):1470-2. DOI: 10.1056/NEJMp1301694
Source: PubMed
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    ABSTRACT: This review aimed to synthesise literature describing the development and/or implementation and/or evaluation of a professional practice model to determine the key model components. A professional practice model depicts nursing values and defines the structures and processes that support nurses to control their own practice and to deliver quality care. A review of English language papers published up to August 2014 identified 51 articles that described 38 professional practice models. Articles were subjected to qualitative analysis to identify the concepts common to all professional practice models. Key elements of professional practice models were theoretical foundation and six common components: leadership; nurses' independent and collaborative practice; environment; nurse development and reward; research/innovation; and patient outcomes. A professional practice model provides the foundations for quality nursing practice. This review is an important resource for nurse leaders who seek to advance their organisation in a journey for excellence through the implementation of a professional practice model. This summary of published professional practice models provides a guide for nurse leaders who seek to develop a professional practice model. The essential elements of a professional practice model; theoretical foundation and six common components, are clearly described. These elements can provide the starting point for nurse leaders' discussions with staff to shape a professional practice model that is meaningful to direct care nurses. © 2015 John Wiley & Sons Ltd.
    Journal of Nursing Management 05/2015; DOI:10.1111/jonm.12309 · 1.14 Impact Factor
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    ABSTRACT: A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents. Forty LTC nurses validated the questionnaire to determine what protocols/procedures are involved in warfarin management. Twenty LTC nurses completed the survey, quantifying the time they spend on procedures related to warfarin management, and how often they performed each procedure for each resident each week. The nurses reported that 26% of their residents were receiving warfarin; the majority (approximately 75%) of these residents began warfarin after admission to the facility. On average, the nurses spent 4.6 hours per week for treatment procedures and monitoring patients initiating warfarin therapy and 2.35 hours per week for each resident who was stable on warfarin therapy on admission. Overall, to care for an average number of newly initiated and stable warfarin patients in a medium-size LTC facility, staff nurses are estimated to spend 68 hours per week. Study limitations include the potential for bias because of the small sample size, representativeness of the sample, and the possibility of inaccuracies in respondents' self-reported time estimation of warfarin-related procedures. In the context of a well-documented and expanding nursing shortage in the United States, the substantial use of time and resources necessary to initiate, monitor, and manage warfarin treatment in elderly LTC patients is of concern. Until the problem of understaffing is resolved, implementation of therapies that are simpler and require less nursing time-e.g. the use of new oral anticoagulants in the place of warfarin-may be a way to free up nursing time for other essential care tasks.
    BMC Nursing 12/2015; 14(1):8. DOI:10.1186/s12912-015-0058-x
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    ABSTRACT: The aim of this study is to determine whether use of supplemental registered nurses (SRNs) from agencies is associated with patients' satisfaction. Employment of SRNs is common, but little is known about whether their use is associated with patients' satisfaction with hospital care. Cross-sectional survey data from nurses in 427 hospitals were linked to American Hospital Association data and patient data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We found little evidence that patients' satisfaction with care is related to the use of SRNs. After other hospital and nursing characteristics were controlled, greater use of SRNs was not associated with patients' global satisfaction, including whether they would rank their hospital highly or recommend their hospital, nor was it associated with nurse communication, medication explanation, or pain control. Employment of SRNs does not detract from patients' overall satisfaction or satisfaction with nurses specifically.
    JONA The Journal of Nursing Administration 03/2015; 45(3):145-51. DOI:10.1097/NNA.0000000000000174 · 1.37 Impact Factor