Guns,laws and public shootings in the United States

Since the late 1990s, there have been increasing numbers of public shootings carried out with firearms in the United States. These tragedies continually renew the regulatory debate concerning public safety while considering civil liberties. Using a unique data set, we investigate whether laws correspond to whether an event occurs and the effects of event-specific characteristics on public shooting outcomes. In particular, we analyse how state-specific gun laws, the types of firearms, the shooting venues and the mental health of the gunman impact the outcomes of public shootings. Results show that most gun laws are unrelated to whether an event occurs. In addition, common state and federal gun laws that outlaw assault weapons are unrelated to the likelihood of an assault weapon being used during a public shooting event. Moreover, results show that the use of assault weapons is not related to more victims or fatalities than other types of guns. However, the use of hand guns, shot guns and high-capacity magazines is directly related to the number of victims and fatalities in a public shooting event. Finally, the gunman’s reported mental illness is often associated with an increase in the number of victims and fatalities.     

Violence against nurses and its impact on stress and productivity

The purpose of this study was to examine how violence from patients and visitors is related to emergency department (ED) nurses' work productivity and symptoms of post-traumatic stress disorder (PTSD). Researchers have found ED nurses experience a high prevalence of physical assaults from patients and visitors. Yet, there is little research which examines the effect violent events have on nurses' productivity, particularly their ability to provide safe and compassionate patient care. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. Participants were asked to complete the Impact of Events Scale-Revised and Healthcare Productivity Survey in relation to a stressful violent event. Ninety-four percent of nurses experienced at least one posttraumatic stress disorder symptom after a violent event, with 17% having scores high enough to be considered probable for PTSD. In addition, there were significant indirect relationships between stress symptoms and work productivity. Workplace violence is a significant stressor for ED nurses. Results also indicate violence has an impact on the care ED nurses provide. Interventions are needed to prevent the violence and to provide care to the ED nurse after an event.     

Observation assistants: sitter effectiveness and industry measures

Patient safety remains a strategic goal and of societal importance for better health care. Direct observation remains an ineffective and expensive means of providing for patient safety. The nursing quality team found that using assessment tools helped to objectively categorize which patients are at risk. Defining patient volume, actual productive sitter usage, and assessing demand for patients in psychiatric crisis and patients at high risk to fall in the form of average daily census provided an easy-to-translate, familiar unit of measure to compare patient volume to demand and utilization. The sitter utilization case was unable to provide correlation of sitter use to decreased fall rates, elopement, or assault behaviors. Currently, there is no research to suggest the use of constant observation reduces the risk of patient harm related to their risk for falling or harming themselves.     

HIPAA privacy rules and compliance with federal and state employment laws: the participant authorization form

Although HIPAA privacy rules do not apply directly to employers or to employment records, they do apply indirectly to employers because employer-sponsored group health plans and all health care providers are covered. HIPAA privacy regulations overlap with federal and state employment laws, and liabilities for breach of confidentiality can be substantial. Employers can use a participant's authorization form to comply with employment laws and company policies. Sample authorization forms are provided at the end of this article.     

Health care reform: current updates and future initiatives for ambulatory care nursing

While the signing of the Patient Protection and Affordable Care Act was a historical event marking the beginning of health care reform in the United States, it signaled the start of a golden age for ambulatory care nursing. Ambulatory care RNs are well-positioned to fully participate in health care reform initiatives. RNs are well-positioned to lead, facilitate, and/or participate in all patient care medical homes' and accountable care organizations' quality and safety initiatives through enhanced use of major ambulatory care RN role dimensions such as advocacy, telehealth, patient education, care coordination and transitional care, and community outreach. RNs are also well-positioned to provide patient-centered care, coordinate care, and manage transitions across ambulatory care settings. For the golden age of ambulatory care nursing to become a reality, initiatives surrounding competencies, education modules, and leadership must be addressed immediately.     

A revolutionary approach to health care cost control: leveraging the power of Web-enabled employee "consumerism"

The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.     

Factors influencing work productivity and intent to stay in nursing

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.     

Occupational health nurses and case management

Employers, providers, consumers, regulators, and society are demanding a systematic method to determine quality and cost efficiency in the provision of health care services in a multidisciplinary continuum of care within a reasonable time limit. Societal and legislative pressure on employers to incorporate and accommodate workers with disabilities or limitations and rising health insurance costs have urged organizations to set up effective strategies. An overview of the historical evolution of case management, trends in engaging workers in a successful return to work process, and a case study are presented.     

Affordable defined contribution health plans can help employers get through challenging times

Defined contribution health plans, modeled on defined contribution retirement plans, seem to be the wave of the future. At a time when employers and employees alike are trying to contain their health care costs, and employers fight to retain their workers, defined contribution health plans can provide solutions for both employers and employees. The health purchasing alliance model has met with success in both the small and mid-size market.     

Universal Health Care and the Economics of Responsibility

In the American health care system the cost of health insurance is underwritten by all three sectors of the economy: 1) households; 2) employers; and 3) government. However, while costs are shared, responsibility is not. The retreat of private firms and government from assuming a substantial share of the burden of health care costs is based on the presumption that health care is an individual’s responsibility, while the contributions of government and the private sector are basically optional - a matter of benevolence rather than responsibility. The outcome of the current debates over health care reform will depend on this issue of responsibility. Who should pay for health care? Is it a collective responsibility or an individual one? In this paper, we explore the economics of responsibility as it applies to health care. In the institutionalist framework, any reallocation of costs must be driven by an underlying philosophy of shared responsibility.     

What is the right profile for getting a job? A stated choice experiment of the recruitment process

We study the recruitment behaviour of Swedish employers using data from a stated choice experiment. In the experiment, the employers are first asked to describe an employee who recently and voluntarily left the firm and then to choose between two hypothetical applicants to invite to a job interview or to hire as a replacement for their previous employee. The two applicants differ with respect to characteristics such as gender, age, education, work experience, ethnicity, religious beliefs, family situation, weight, and health, but otherwise have similar characteristics as the previous employee. Our results show that employers prefer not to recruit applicants who are old, non-European, Muslim, Jewish, obese, have several children, or have a history of sickness absence. We also calculate the reduction in wage costs needed to make employers indifferent between applicants with and without these characteristics, and find that wage costs would have to be reduced by up to 50 % for applicants with some characteristics.     

Why managed care has gone too far

Managed care has not solved employers' problems with rising health care costs; instead, it has created another set of problems, this author maintains. She suggests steps that employers can take to enhance the quality of health care for their employees and prevent further damage from the excesses of managed care.     

Reassessing retiree benefits: the new challenge

For most employers, uncertainty about the future shape of the U.S. health care system, rising health care costs and FAS 106 accounting rules mean it is important to manage retiree medical costs. Survey data shows many employers are taking steps to manage their future retiree health care costs. These steps include reducing benefit levels, introducing service-related contributions and introducing managed care elements to retiree medical plans.     

Rent-Sharing And Wages: Product Demand Or Technology Driven Premia? 1

There is a renewed interest in non-competitive wage determination. Studies have shown that firms share rents with workers. How such rents are appropriated by firms to share, or why firms may wish to do so, is still an area of debate. Using a unique data set, where workers are matched directly to their workplace, we use instrumental variable estimation to examine which shocks create rent-sharing and the size of the rent-sharing effects. The results find rentsharing is strongest for establishments investing in new process technology, and for employers who wish to share their successes with their employees.     

Sadly caught up in the moment: an exploration of horizontal violence

The behaviors associated with horizontal violence can have negative consequences for nurses, patients, and organizations. Participants in this study were sent a survey that listed nine behaviors associated with horizontal violence. They were asked if they had witnessed, experienced, or neither witnessed nor experienced the nine behaviors. Participants were also asked to respond to three open-ended questions intended to capture their uniquely personal experiences with horizontal violence. For all but one behavior, the majority of participants stated they had witnessed or experienced eight of the nine behaviors associated with horizontal violence in their workplace. In response to the findings of this study, an educational program was developed to assist nurses in recognizing and responding to horizontal violence.     

A fragmented patient safety concept: the structure and culture of safety management in health care

The uniform and visible commitment to safety management is a cultural and structural change that health care organizations have not typically attempted. Committee structures are just one example of how culture drives structure in managing health care safety. The question is: "Are we interested in making nonpatient safety programs as well understood and as culturally significant as patient safety programs?" Models exist to institutionalize safety management in health care. We need only look to the JCAHO or OSHA and other high-hazard industry models for examples of safety management. Change requires a focus on safety, not occupational safety or patient safety, but just safety. In health care, safety would be a key characteristic of organizational culture. The organizational expectation is then that all employees will work safely and practice safety. Employees will apply safe practices when handling chemicals, in lifting, and when giving medications. Only when safety imbues the work and decisions of each employee in this way will the highest level of safety be attained.     

Evaluate and communicate health care benefits

Both employers and employees need appropriate information to make intelligent decisions about health care benefits. For employers, analysis of health care data offers an approach to monitoring quality care and can provide a tool for controlling costs. For employees, an education and communication strategy is probably the single most important factor influencing both program utilization and employee acceptance.     

MNT: an innovative employee-friendly benefit that saves

In an effort to address the rising cost of health care within employee and retiree populations, many large employers are turning to an innovative health care solution: the registered dietitian and medical nutrition therapy and prevention. Research and case histories show the effectiveness of this approach.     

Self-funding health insurance for small employers: is it the right way to go?

Self-funding offers small employers an alternative approach to providing health care benefits for their employees. It may not be appropriate for every small employer but, in situations where it is feasible, self-funding offers employers a way to get a measure of control over health care costs while providing the benefits employees expect.     

Multiple HMO/indemnity plan supplement design: a managed care strategy for employers with high HMO enrollment

This article outlines a health care benefits strategy that combines features of the multiple HMO choice approach and the point-of-service approach. Although this plan design may not be appropriate for all employers, it may provide the greatest long-term cost savings for employers with high HMO enrollment, according to the author.