Job preferences of students and new graduates in nursing

This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated. Overall, salary remains the most important feature in increasing the probability that a job will be selected. ‘Supportive management/staff’ and ‘quality of care’ follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank ‘supportive management/staff’ above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes.     

The impact of state regulations on nursing home care practices

This article assesses the effect of the minimum quality standards of deficiencies and nurse staffing requirements on the nursing home care practices of physical restraint, indwelling urinary catheter, and feeding tube use. National longitudinal data on nursing homes reveal that the effect of specific deficiency citations on care practice use depends on the clinical complementarity or substitutability of the deficiency and the specific care practice, while a high number of deficiencies can lead to a greater use of each care practice. Higher direct care staffing requirements increased the use of physical restraints and decreased the use of feeding tubes. Increases in licensed nursing staff requirements had no effect on the care practices studied. Regulators should be aware that using minimum quality standards when quality is multidimensional creates incentives for offsetting quality improvement practices.     

Career coaches for nursing: a strategy for increasing your ROI

Career Coaches for Nursing was created as an innovative program for the nursing staff at a large, expanding Midwestern tertiary health care organization. In the 2-year start-up period, the new program met challenges and identified many system-wide, as well as local issues for improvement. A decrease in turnover and the associated cost savings from improved employee retention provided a positive return on investment within the first 2 years of the program's existence.     

Does organizational ownership matter? Objectives of employees in public,nonprofit and for-profit nursing homes

Does organizational ownership matter for employees? We conducted a discrete choice experiment to reveal employees’ objectives in for-profit, nonprofit and governmental nursing homes. The results indicate that differences in objectives among nursing home staff are at least partially related to differences in ownership type. More specifically, we find that employees of public nursing homes are less extrinsically motivated than their for-profit and nonprofit counterparts. However, the results also show that employees of for-profit, nonprofit and governmental nursing homes are trading off output quality and output quantity differently, in line with the view that public providers of elderly care are pursuing a supplier-of-last-resort objective function.     

A magnetic strategy for new graduate nurses

With the shortfall of nurses, more health care organizations are actively recruiting new graduate nurses. To translate active recruitment to successful retention, however, these newest nurses need support to make the adjustment from the security of a protected academic environment to the demands of a professional nursing career. Nursing turnover occurs when their role transition is unsuccessful. A unique model implemented in 2003 transformed new graduate nurses into confident staff nurses in an acute care setting. The insights gained and the investments required for a "magnetic" strategy to make new graduate nurses successful new staff nurses who stay with the organization are revealed.     

Staff nurse financial management committees--the nurse manager's guide to effective financial performance

As Cohen states (1991, p. 25), "The future role that nursing will play in the health care delivery system is one of many major issues faced by contemporary nursing...Nursing must be able to determine realistically the cost of and evaluate the effectiveness of nursing care provided to its patients." A unit-based financial management committee is one very effective way of teaching the skills needed for the professional nurse to advance the practice in financial management. This will help nursing gain the professional status that they have always worked for. But beyond these very lofty ideals, a staff nurse managed financial management committee can make the nurse manager's life much easier. Staff nurses need to understand and accept the importance of managing the financial as well as the quality side of patient care. When this happens, the budget becomes theirs. Nurses develop a sense of ownership of the budget and learn how to effectively manage the unit's finances. Much staff nurse brain power is not used. Systems must be developed to access nurses' effective ideas for financial management--first in a financial management committee and then on the unit. Not only will this develop the professional status that nurses need and deserve, but it will also impact the cost of health care. In a society where the cost of an appendectomy requires Dayton Hudson to sell 39,000 Ninja Turtle action figures, Atlantic Richfield to sell 192,000 gallons of gas a day, Anheuser-Busch to sell 11,627 6-packs of 12 oz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series the current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify the nursing care will be described.     

Long‐term care and pay‐for‐performance programs

Pay‐for‐performance programs are gradually spreading across Asia. This paper builds on the longer experience in the United States to offer lessons for Asia. The Center for Medicare and Medicaid Services has introduced several pay‐for‐performance programs since 2012 to encourage hospitals to improve quality of care and reduce costs. Some state Medicaid programs have also introduced pay‐for‐performance for nursing homes. Long‐term care providers play an important role in hospital pay‐for‐performance programs because they can affect the readmission rate and also total episode payments. A good pay‐for‐performance program will focus on improving quality of care that affects health outcomes. In addition, that quality must vary across providers and be measurable. Furthermore, it is important that the measures be reported in a timely way, that both demand and supply respond to the measures, and that the measures be risk adjusted. Empirical data from Medicare beneficiaries in the state of Michigan show that mean episode payments and readmission rates in skilled nursing facilities vary widely and are sensitive to the number of observations. These practical matters create challenges for implementing pay‐for‐performance in practice. There is an extensive literature review of pay‐for‐performance in long‐term care in the United States and in Asia.     

Expanded role of nursing in ambulatory managed care. Part II: Impact on outcomes of costs, quality, provider and patient satisfaction

This evaluation project used a triangulation of methods and data sources to link the expanded role nurse clinician (NC) to outcomes of costs, quality, and satisfaction in managed care. Results of patient surveys, case studies, cost-benefit analyses, interviews, focus groups, and HMO documents suggest that the impact of the role has benefit far beyond its costs. This article builds on an earlier article (Nursing Economic$, Vol. 17, No. 1). Part I reviewed literature on expanded role nursing in population management, and described the development of the NC role. In Part II, the NC expanded role is linked to organizational outcomes of costs, quality, and satisfaction. Results here could be used by managers and planners to provide rationale for implementing expanded nursing roles in managed care in order to improve ambulatory care processes, recruit and retain nurses, reduce costs, and increase patient and provider satisfaction.     

Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care--Part II

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series, current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify nursing care will be described. In this article, the ongoing implementation of the system, its incorporation into the organization's established computerized appointment system, reliability measures, and related performance improvement activities will be discussed.     

Workload measurement in a community care program

The delivery of services in the community is a expanding area of health care due to the rapid shift from institutional to community care. However, limited attention has been given to accurately predict or measure nursing resource utilization. A workload measurement tool developed by the community care program at WestView Health Centre (Stony Plain, Alberta, Canada) sought to address the unique challenges of determining workload while caring for clients in their own homes. The implementation of this tool facilitated improved understanding of work requirements associated with each client on caseload. The continued use of this tool will lead to refinement of case mix and professional utilization, and may show benefits in the future for novice nurse growth, staff retention, and satisfaction.     

An interview with Karlene M. Kerfoot. Interview by Connie R. Curran

Innovation is the key to achieving higher levels of quality and productivity and reducing turnover. Karlene M. Kerfoot, PhD, RN, CNAA, believes the future of nursing in hospitals is a unit-based shared governance structure. Dr. Kerfoot is a member of the Nursing Economic$ Editorial Board and authors the journal's "Nursing Management Considerations' column. In this interview, she outlines her programs, experiences, and philosophies for attaining her goals.     

当前乌鲁木齐养老机构服务中存在的问题与对策

随着我国老龄化进程的不断加快，社会对养老机构的需求越来越大。在大力发展养老机构的同时，应注意提高养老机构的服务水平。养老机构在设计和提供服务时，应以老人的需要为前提。     

The competitive nature of the nursing home industry: price mark ups and demand elasticities

Nursing home markets are likely to deviate from a competitive structure because of limitations on entry imposed by Certificate of Need (CON) regulations and the potential for product differentiation along such attributes as location, religious affiliation and quality. This paper investigates the structure of nursing home markets in New York State by calculating price mark ups and residual private pay demand elasticities. It shows that the residual demand elasticity is bound by estimates based on price mark ups above marginal costs and above Medicaid rates. This approach allows estimation of demand elasticities in all markets, whether or not CON regulations constrain bed supply. Mean price elasticities (in absolute value) calculated for nursing homes in New York State in 1991 ranged from 3.46 to 3.85.     

Minimum nurse staffing ratios for nursing homes

The authors explored minimum nurse staffing ratios for nursing homes using production function simulations. Minimum levels of registered nurse hours per resident day were 0.31, 1.83, and 3.3 at 50%, 75%, and 90% levels of quality respectively. These results suggest that efficiency-oriented minimum nurse staffing points exist, and could be used to inform policymakers and nursing home administrators on better resource allocation and health care delivery.     

Nursing home costs and quality of care outcomes

The relationship between cost and quality of care in nursing homes was examined using quality indicator measures of resident outcomes. While each individual quality measure makes only small contributions to costs, when considered across the facility, quality could have a substantial financial impact on the operations of the home.     

Staffing for end of life: challenges and opportunities

What would staffing look like if we committed to end-of-life experiences that were designed to honor the needs of the person dying, their loved ones, and the needs of the nurses and care team involved in the dying experience? When we think about the experience of death in a health care setting, it is essential we look at the needs of both patients and caregivers. Attending to the needs of patients and their families facing death, even if well defined, can be difficult to design into staffing plans and budgets in a way that would not put an organization at further financial risk. If we are going to commit to staffing practices that honor dying, in all it's dimensions and for all who are potentially impacted, we will most likely have to step outside traditional thinking to find answers.     

The nursing care technologist: an interview with Linda Sims Matessino

To better promote nursing, provide quality patient care, and address long-term problems posed by the nursing shortage, Ochsner Foundation Hospital of New Orleans developed and implemented the role of nursing care technician. In this interview, Linda Sims Matessino, Associate Hospital Director and Director of Nursing Services, details this position and how it has benefitted Ochsner Foundation Hospital.     

ELDERLY ASSETS, MEDICAID POLICY, AND SPEND-DOWN IN NURSING HOMES

Recent economic research has suggested that Medicaid long-term insurance may reduce the personal savings levels of elderly citizens. This analysis shows that the opposite behavior, due to welfare aversion, actually happens. Barring any behavioral effects, personal wealth and income alone should determine the length of time an individual must stay in a nursing home until spend-down occurs. Wealth and income data from two different samples of the elderly are used to predict the distribution of time until spend-down, which is then compared with the actual distribution of the time until spend-down among residents of nursing homes. Contrary to expectations, it appears that the elderly receive transfers to avoid Medicaid eligibility. This result cannot be explained away by sample selection, demographics, or uncertainty about prices. One implication of this result is that Medicaid could expand eligibility by raising the asset limit without dramatically increasing expenditures or the number of residents who spend-down.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.