Telephone nursing: evidence of client and organizational benefits

Telephone nursing (TN) or telephone triage (TT) has been identified as part of a successful cost-reduction demand management strategy. The author examines TN utilization and related client satisfaction, client education, reduction in drop-in clinic visits, and unnecessary ER and urgent care visits associated with an outpatient pediatric clinic population. This study examined 25% of the total of an average of TN 120 phone calls processed by this Southwestern clinic in an average summer month and achieved an 87.3% response rate to followup study questions. "Telephone nursing was performed by specially trained and experienced RNs using approved, written, clinic-specific protocols." The primary goals of the TN program was the "efficient use of health care resources" and provision of the "appropriate level of care at the appropriate time." Over 80% of the callers surveyed reported that if they hadn't been able to speak to the nurse they would have sought medical care elsewhere.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.     

Conceptual frameworks used in funded nursing health services research projects

Theories not only suggest ideas for research, but they provide order and logic to an investigation and limit the number and type of variables to be considered to a reasonable few. Although relatively little health services research is done within nursing, there is a growing appreciation of the need for knowledge related to the use, costs, quality, delivery, organization, financing, and outcomes of health care and how nursing practice influences these variables. Conceptual frameworks used by investigators in funded grants from the Agency for Healthcare Research and Quality show that workforce-related health services research of nursing phenomena is based on a wide variety of conceptual models, many of the investigator's own invention. Ultimately, there may emerge new theories or conceptual frameworks that combine clinical, organizational, financial, and outcome variables from the unique perspective of nursing. Such conceptualizations will guide future researchers and add coherence to the body of health services research into nursing issues.     

Nursing overtime: why, how much, and under what working conditions?

To provide the best care to patients, the physical wellness of nursing staff is essential. Current evidence indicates long work hours can lead to adverse nurse and patient outcomes. To provide quality and safe patient care, both staff nurses and nurse managers need to recognize the adverse effects of overtime, whether it is mandatory or voluntary. Results of this study showed overtime was not used more when there was an increase in nursing shortages. Further, overtime was not used to control shortages; rather, understaffing was an underlying condition of the nursing practice, at least in the study sample. Thus, efforts must be made not only to prevent nurses from working long hours, but also to resolve the problem of understaffing in order to retain qualified nurses in hospitals.     

基于计划行为理论的知识隐藏行为拓展模型构建

基于计划行为理论(TPB)框架,结合动机理论、社会交换理论、心理占有理论等构建知识隐藏行为形成机制拓展模型。研究发现：(1)知识隐藏态度受到心理距离、结果期望的影响,知识隐藏主观规范受到组织网络结构中网络惯例的影响,知识隐藏感知行为控制受到知识权力、知识心理所有权的影响;(2)知识隐藏意愿受到知识隐藏行为态度、知识隐藏主观规范、知识隐藏感知行为控制以及过去行为的影响,知识隐藏意愿与知识隐藏感知行为控制可预测知识隐藏行为的发生;(3)创新氛围、双元领导和大五人格在知识隐藏意愿与知识隐藏行为之间起调节作用。上述拓展模型的构建有助于提升TPB的解释度并扩大适用范围,深入了解员工知识隐藏行为背后的行为逻辑,对于减少知识隐藏行为、促进知识流动、制定管理制度具有重要理论意义和实践价值。     

临床护理路径在耐多药肺结核患者健康宣教中的作用

目的评价临床护理路径在耐多药肺结核患者健康宣教中的作用。方法选取耐多药肺结核患者113例按就诊顺序分为研究组57例和对照组56例。对照组患者给予常规健康宣教,研究组患者给予临床护理路径健康宣教。对比两组患者健康知识的知晓情况及患者对健康宣教工作的满意度。结果研究组患者健康知识的知晓得分为（97±9）分,对照组得分为（83±8）分（P〈0.01）;研究组患者对健康宣教工作的满意度得分为（93±7）分,对照组得分为（82±7）分（P〈0.01）。结论耐多药肺结核患者实施临床护理路径健康宣教可有效提高患者对健康知识的掌握,提升护理人员健康宣教工作的质量。     

When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution

With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.     

How should we collect data on the nursing workforce?

R esearchers who study the nursing workforce use data about nurses and data about nursing jobs. Diifferent approaches - sample surveys and relicensure surveys - used to collect data on RNs, and the benefits and weaknesses of these approaches, are reviewed. Predicting the future supply of nurses is more complex than estimating the current supply, as factors that affect future supply must be considered. Simple forecasts can be created with relatively few variables, which could be collected through relicensure surveys. However, more detailed assessments of potential retirement patterns, changing family norms regarding childcare and household work, and movements into higher education require the rich data more often found in sample surveys.     

Influence of hospital context on cost and length of stay following cardiac catheterization

This study attempted to link health care activities and outcomes, taking into account characteristics of the health care system, the work group, and the individual. Results indicated that organizational structure and work group process had a greater influence on cost and derived length of stay (a measure of efficiency) than did the individual-level variables. The findings of this study add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work.     

The impact of sustained attention on labor market outcomes: The case of Ghana

In this paper, we go beyond traditional measures of cognitive abilities (IQ) in explaining labor market and social outcomes in developing countries. We exploit a rich dataset from Ghana that provides information on demographics, labor market outcomes, and a direct measure of cognitive ability along with other test scores to construct a measure of sustained attention. Our work is therefore related to the broader literature in psychology on the importance of executive function on individual behavior and outcomes. We find that, at least for the case of Ghana, after controlling for IQ and other covariates, higher levels of sustained attention are associated with higher educational attainment and a higher likelihood of being employed in a white‐collar job.     

Cost of hospital care for elderly at risk of falling

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions.     

Human resource management for learning through knowledge exploitation and knowledge exploration: Pharmaceuticals in Mexico

This paper investigates the influence of human resource management practices on the likelihood that a firm performs in-house R&D. R&D is broadly interpreted as learning—a mechanism promoting absorptive capacity and supporting technology capability-building. Firms can choose between two learning strategies: they can exploit existing knowledge, or perform more complex explorations and acquire new knowledge. Different knowledge requirements associate with distinct R&D outcomes with varying degrees of novelty for the firm. Findings are supported with evidence from the pharmaceutical industry in Mexico. The analysis reveals positive linkages between human resource management practices and learning at firm level. The relationship is contingent on factors such as expected R&D outcomes, or the novelty of the knowledge required by the firm. The provision of training revealed the more consistent, positive influence on the likelihood that pharmaceuticals firms perform R&D in Mexico.     

Visits to the client when competing for new consulting contracts: sourcing information or influencing the client?

Consulting firms (CFs) sell services on a project basis to many clients and must therefore continuously tender for new contracts. One frequently used strategy by CFs is to visit the clients in connection to the tenders. The reasons to the visits are: (1) to influence the client in his decision-making (e.g., marketing, bribing); and/or (2) to source information about the project so that a better proposal can be submitted. Using a unique database on individual export proposals submitted to emerging markets, which of these two reasons is the most important is examined empirically The estimations show that influencing the client dominates as explanation to the visits. Although it is not possible to determine whether this influence takes the form of bribing or marketing, all conditions necessary for bribes to occur are fulfilled.     

Work satisfaction among California registered nurses: a longitudinal comparative analysis

California's minimum nurse-to-patient staffing ratio law, the nation's first, was implemented in 2004. This study had two aims: (a) to evaluate the effect of the nurse-to-patient ratios law on nurse job satisfaction in order to advance the debate over the merits of nurse staffing law, and (b) to compare California nurses who were satisfied against those who were not, in order to facilitate the development targeted retention interventions based on empirical evidence. The sample's overall job satisfaction increased significantly as the years passed, suggesting the nurse-to-patient ratios law was associated with improvements in nurse satisfaction. Satisfied RNs were more likely to have a balanced and financially secure life that included a partner, children living at home, higher hourly wages, and higher income from sources other than a nursing job. Nurses working in direct patient care positions remained dissatisfied in larger proportions than those working in other types of positions, even after the nurse-to-patient ratios were implemented. More nurses are satisfied today than before the ratios; nevertheless, far too many nurses (18.5%) have job satisfaction scores that are neutral or worse.     

Using a spreadsheet/table template for economic value added analysis

Translating clinical research into practical applications that are cost effective has received significant attention as staff nurses attempt to expand new knowledge into an already complex daily workflow. spreadsheet/table template created in a word processing format can assist with setting up and carrying out the analysis of costs for comparing different approaches to routine activities. By encouraging nurses to take the initiative to examine parts of everyday nursing practice with an eye to cost analysis, significant contributions can be made to maximizing the bottom line.     

The MISSCARE Survey-Turkish: psychometric properties and findings

One measure of the process of nursing care is missed nursing care, which refers to any aspect of required care that is omitted either in part or in whole or delayed. Little is understood about how the quality and processes of nursing care differs among countries around the world. The aims of this study were (a) to test the psychometric properties of the MISSCARE Survey-Turkish and (b) to compare the extent and type of missed care as well as reasons for missing care between Turkey and the United States. There was less missed care reported by Turkish nurses as compared to U.S. nurses (p < 0.0001). Turkey nurses identified more problems with inadequate staffing resources (p < 0.0001), materials resources (p < 0.0001), and communication/teamwork (p < 0.0001) as reasons for missed nursing care than did U.S. nurses. Missed nursing care is a critical problem that needs to be addressed in both countries.     

The impact of nursing on patient and organizational outcomes

The impact of nursing on patient and organizational outcomes has received significant attention from researchers in the past 10 years. Although some research has been based on a theoretical framework, to date, there has not been one, consistent framework that can guide this research. In addition, the frameworks that have been used do not identify nursing as the pivotal concept in the model. The purpose of this article is to identify a framework to guide such research with an emphasis on nursing as the essential concept. Unit culture, nurse staffing, staffing mix, and other variables do not have a direct effect on outcomes. It is only through these variables' influence on the delivery of nursing care that outcomes are affected.     

The impact of nurse staffing on hospital costs and patient length of stay: a systematic review

Research examining the relationships between nurse staffing, hospital costs, and length of stay is varied using a range of methods and definitions. This lack of coherence in definitions and measurement tools for cost and length of stay makes it difficult to conclude with certainty the results of nurse staffing on hospital cost and length of stay. However, the evidence reflected that significant reductions in cost and length of stay may be possible with higher ratios of nursing personnel in hospital settings. Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer than necessary. Patient costs were also reduced with greater RN staffing as RNs have higher knowledge and skill levels to provide more effective nursing care as well as reduce patient resource consumption. Hospital administrators are encouraged to use higher ratios of RNs to non-licensed personnel to achieve their objectives of quality patient outcomes and cost containment.     

Navajo nation public health nurses inspire thoughts on health care reform

The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.     

EFFECTS OF DRUG ABUSE TREATMENT ON LEGAL AND ILLEGAL EARNINGS

Although recent research has shown that drug abuse treatment reduces drug use and criminal activity in some clients, the impact of treatment on clients' post-treatment labor market behavior is relatively unknown. This study uses data from a longitudinal survey to analyze annual legal and illegal earnings for 2,420 drug abusers. The analysis focuses on two different time intervals—one year before entering a drug abuse treatment program and one year after leaving the same program. It describes client characteristics, labor market variables, and treatment history, and estimates the effects of length of time in treatment on post-treatment earnings. The regression analysis shows that length of time in treatment had a positive (negative) and statistically significant impact on real legal (illegal) earnings following treatment for methadone and residential clients, but the magnitude was small; accounting for possible selection bias had little effect on the results. Although residential clients experienced the largest relative changes in earnings outcomes, simply comparing the direct cost of residential treatment with the benefits from improved legal earnings and lower illegal earnings suggests that additional residential treatment is not cost-beneficial.