Development of a quality index allows a quantifiable synthesis of selected patient-care outcomes and service costs. The quality index provides potential buyers of healthcare a way to judge the costs associated with a particular level of quality and thus, compare the value of alternative services.
Research design is the plan, structure, and strategy of investigation for answering the research question. The correct design helps isolate items of concern so that they can be examined under known conditions; it eliminates bias and reduces the margin of error, enabling the researcher to state confidently conclusions on which to base future decisions and research. Regardless of the type of research proposed, following a logical plan, such as we have described here, provides the framework for an effective study. The results of well-planned research are contributions to the growing body of nursing knowledge.
This biannual department, sponsored by the Council on Graduate Education for Administration in Nursing (CGEAN), provides information updates to nurse leaders on educational trends, issues, and research important for effective health system administration. The CGEAN Web site can be accessed at http://www.cgean.org.
Maximization of the nurse administrator's managerial time is the focus of this article. Activities inventory, goal setting, assessing peak and low times, scheduling activities, using transition times, streamlining paperwork, using the telephone, office visits, and meetings are discussed. The author addresses planning, organizing, staffing, directing, and controlling at the organizational level as ways to maximize organizational time.
Committees and other groupings of individuals can be utilized to advance management objectives. Various approaches are explored in this article which is one chapter of "The Nurse As Executive", a book to be published next spring by Contemporary Publishing, Inc., Wakefield, Massachusetts.
As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on managing social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the fifth in a 5-part series on applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, the concept of control is explored from a complex systems perspective.
Is the health care system giving the elderly the opportunity to regain and maintain health? Society, or a particular community culture, establishes the norms of who is a deviate In our society, Health Institutions establish norms of who will receive active treatment programs and what behavior will be tolerated and for how long. Our personal and cultural attitudes toward the elderly have pervasive effects which may distort our knowledge and therefore the adaptation of nursing practice to the psychosocial needs of the elderly.
Implementing change in organizations is a key nursing leadership competency. At the same time, it is a daunting responsibility. Fortunately, models of successful change illustrate useful concepts for leaders. Change concepts embedded in successful models include careful use of power, reason, reeducation, structure, behavior, and technology. This article discusses models of change. Learning from models may help nurse executives avoid perils such as change fatigue and may promote smoother movement toward safer systems of care.
Critical care has enjoyed unobstructed growth during the past two decades; however, to remain viable, process and role changes are pivotal to ensuring continued quality, cost-effective, and efficient care. In this article, the second in a two-part series, the authors describe restructuring efforts, inclusive of their measurement and evaluation strategies, within four critical care units at an acute care, tertiary institution. Special emphasis is placed on the process, the authors' observations, and lessons learned to date. Part 1 (September 1998) presented evaluation data of the effects of hospital restructuring on patient and nurse satisfaction, costs of care, and clinical quality in four medical-surgical units.
This descriptive integrated review of research on the use of unlicensed assistive personnel in nursing is presented in two parts. In this issue, part 1 describes the methods used to find and critique research related to unlicensed assistive personnel in nursing. It includes the conceptual model and findings related to the variables studied. Part 2 of this review, which is scheduled for publication in the next issue, will present research findings, conclusions, and recommendations.
This article is part 2 of a descriptive integrated review of research on the use of unlicensed assistive personnel in nursing. Part 1, published last month, described the methods used to find and to critique 29 research articles; it included the conceptual model and the variables identified in the studies. Part 2 presents a synthesis of the 29 studies data conclusions, implications and recommendations.
The author reviews the causes of nursing shortages and surpluses and examines data from California hospitals to demonstrate how these cycles are expressed in the demand for and wages of nurses.
Nursing shortages have been reported cyclically for more than 50 years in the United States. There has been little data analysis demonstrating the relationship between the current shortage and changes in wages and nurse staffing.
Analysis of longitudinal hospital and patient data from the California Office of Statewide Health Planning and Development. Summary statistics of patient utilization, nurse staffing, and nurse wages were computed.
The data demonstrate that cyclical shortages are accompanied by higher wages and employment. This has been true in recent years. However, in medical-surgical units, hours per patient day declined between 2001 and 2002, perhaps reflecting the inability of hospitals to find more nurses to meet staffing goals.
Nurse staffing per patient day and per discharge have remained stable, despite concerns about low staffing levels. Improved measures of patient care needs and studies of the precise staffing requirements for different types of patients and configurations of staff are required to make recommendations about staffing and policy.
Nursing administrators and nurse recruiters coping with staffing shortages can profit from some recent studies of the causes of nursing turnover. Research reveals that the problem lies not in the motivations or characteristics of individual nurses but the nature of hospital nursing jobs and incentive structures. Using the research findings as a basis for discussion, Weisman suggests target areas for administrative intervention in the design of hospital nursing jobs. Her insightful commentary provides stimulus for some basic rethinking of the nature of nursing jobs and the traditional employer-employee relationship between hospitals and nurses--as well as some specific suggestions for "recruiting from within" to retain those productive nurses in whom the hospital has already invested time and money.
This article describes research on the content and practice of the first-line nurse manager role and the state of the art of selection of nurse managers for this role, as reported in the nursing literature (1982-1992). It compares the current practice of nursing management selection to research on management selection strategies in business and suggests how selection of nurse managers can be conceptualized within a nursing administration conceptual/theoretical framework. The authors identify implications for nursing administration practice and research.
Predicting the future is a risky effort for nursing administrators. What we can do is reevaluate our past and learn how the lessons of prior eras can help us understand the trends affecting health care and nursing and plan strategies for moving nursing forward. Specifically, to move forward we must effectively deal with our image, mechanism for educating students, attainment of public accountability and professional autonomy, political skills, and becoming more actively involved in research to document the value of nursing.
In a March 1998 Journal of Nursing Administration article, I reported that nurse staffing did not in fact decline through 1996 in California where concerns about nurse staffing have been prominent. In this article, I provide a data update indicating an increase in the number of hours worked by nursing personnel in California hospitals through 1998, mostly because of an increase in the number of hours worked by registered nurses. The hours worked by nursing personnel and registered nurses per case-mix adjusted discharge and per adjusted patient day have remained stable since 1996 Thus, the most recent data indicate no decline in nurse staffing in the 1990s.
The ill elderly are more at risk for recurrent hospitalizations than any other segment of the population. What is known about hospital admission readmission of chronically ill older adults and how can this information be used to develop cost-effective strategies? The authors found variation in percent reimbursement (43% to 93%) of overall average charges, which indicates that further examination of low reimbursement major diagnostic categories can be useful. Hospital readmission data should be used to improve quality of care while containing hospital costs.
The authors document the 1-year outcomes of the postbaccalaureate residency program jointly developed and implemented by the University Health-System Consortium and the American Association of Colleges of Nursing. Data on 2 cohorts of residents (n = 679) in 12 sites across the country are presented. The 1-year termination rate was 12%, after those lost to the program because of National Council Licensure Examination failure, serious illness, or death were eliminated from the analysis. Additional analyses using data collected at entry to the program, 6 months, and 1 year using 3 instruments, the Casey-Fink Graduate Nurse Experience Survey, the Gerber's Control Over Nursing Practice Scale, and the McCloskey Mueller Satisfaction Scale, are presented and discussed.
This bimonthly department, sponsored by the AONE, presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.
The unprecedented transition in the United States healthcare delivery system necessitates a nursing work force that can rapidly adapt to the changing care patterns required by the populace. The south Texas regional healthcare providers and community leaders are addressing this need for responsive personnel Nursing Work Force: Beyond 2000 Plan. This 3-year multidisciplinary initiative is one of 20 projects in the Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development Program. The Texas project brings together researchers from nursing, geographic information systems, public health, computer science, and healthcare administration in collaboration with a community-based consortium. This consortium is composed of all levels of nurse educators, all types of nursing care employers, the Texas League for Nursing, the Texas Nurses Association, the Texas Higher Education Coordinating Board, representatives of the Texas Legislature, nursing students, and the business community. Their purpose is to institute a work force development program specifically designed to respond to the healthcare needs of the citizens in a specific region in south Texas.
The objective of this study was to examine RNs' experiences with health information technology (HIT) and their perceptions of the effect of this technology on quality of care and daily work. The adoption and use of HIT are expected to increase substantially over the next 5 years because of policy efforts at the federal and state levels. Given the size of the RN workforce and their critical role in healthcare delivery, their experiences with HIT could help adoption efforts. The method used was a nationally representative survey of 1500 nurses with a 56% response rate. Findings suggest wide variation in the availability of HIT functionality, with functions more likely available to hospital RNs. Overall, RNs perceived the effect of these technologies on quality of care and their daily work as positive. Ensuring that HIT systems are relevant to and usable for RNs will be a critical component in achieving the meaningful use of these systems.
The demand for knowledgeable and skilled nursing leaders at the first, middle, and executive levels of management in healthcare organizations drove a multi-phased project about the kinds of nurse managers who will be needed in the future and their educational needs. This first article in a two-part series describes seasoned nurse leaders' opinions about the educational preparation, experiences, and competencies desired in nurse managers for the year 2020.
The demand for knowledgeable and skilled nursing leaders at the first, middle, and executive levels of management in healthcare organizations drove a multiphased project concerning the types of nurse managers that will be needed in the future and their educational needs. In Part 1 (June 2003), national nurse leaders identified the increased need for knowledgeable and skilled nurses in first-line, mid-level, and executive management positions in the healthcare delivery system. This article describes the second Vision 2020 survey of nurse managers in Massachusetts on the current and future demand for nurse managers and their academic preparation and continuing education needs. It concludes with a model curriculum revision for a master's program in nursing management for the public urban university in Boston.
This column, presented by the executive vice president and chief officer of the American Nurses Credentialing Center, Linda Lewis, MSA, RN, NEA-BC, FACHE, discusses a topic of interest to nurse executives as they develop plans for the nursing workforce. Ms Lewis addresses the direction of the Magnet Recognition Program® with regard to requirements for staffing mix.
Why are graduate nursing administration (MSN/A) program enrollments declining? Do these programs truly meet the needs of potential students? Will they help them to be effective and innovative partners on the healthcare management team? The authors explore reasons for the decline in MSN/A enrollments, potential negative outcomes, and currently available alternative educational choices. They then suggest MSN/A program redesign and other courses of actions. Nurse administrators and nurse educators must be aware of these trends and have equal input into the creation of a viable MSN/A program that will be able to survive in the 21st century.
Decreasing length of in-patient stay and increasing the number of outpatient procedures being performed has led to the creation of the 23/24-hour observation patient. In this study, the authors show that the addition of observation patients to aggregate workload data causes a meaningful staffing deficit 60-90% of the time in three out of four clinical areas studied. The authors explore the statistical impact on staffing of the addition of observation patients to aggregate inpatient data and provide several strategies for staffing.
This bimonthly department, sponsored by the American Organization of Nurse Executives (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.
Since the Taft-Hartley Act was amended in 1974 to include nonprofit hospitals under the National Labor Relations Act. union organizing attempts in health care facilities have sig-nilicantly increased. These new amendments are analyzed; the case law and decisions rendered by the National Labor Relations Board are explained.