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.     

Capacity planning in hospital nursing: a model for minimum staff calculation

An aging population, emerging technology, heightening patient expectations, rising health care costs, shorter patient stays, and growing pressure to improve quality have made the management of nursing resources even more critical today. While approaching a model for staffing levels, the authors considered factors such as patient acuity, work redesign, and minimum quality standards. The methodology for analysis included estimating the time needed to complete nursing tasks and calculating the average number of tasks per patient. With respect to nursing quality measures, the study examined the adequacy of nursing documentation including admission history, assessments, nursing procedures, and discharge report as well as nursing-driven outcomes such as fall and phlebitis rates. Lastly, the authors determined the theoretical number of staff needed to provide nursing care according to quality standards.     

Information technology, nurse staffing, and patient needs

As health care organizations increasingly adopt health information technology, time-sensitive data that track patients' requirements for nursing care and nurses' responsiveness to these needs might be available to support evidence-based nurse staffing decisions. care information technologies available in hospitals and on nursing units may provide valuable sources of information that can be translated into usable data. In this study, the usefulness of electronic data obtained from a nurse tracking call light system as a source of information for quality measurement was explored. The findings point to what might be under-utilization of existing health information technology to track patients' needs and nurses' responsiveness, patient census, and patient movements. The authors recommend health information technology be used less as support for other organizational systems and more as an administrative resource that can allow nurse executives to be more actively engaged within and across nursing environments.     

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.     

Ambulatory care registered nurse performance measurement

On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.     

The implications of nurse staffing information: the real value of reporting nursing data

There is a dearth of information about the relationship between the patient care contributions of nursing and its financial contributions to an organization. As consumers and legislators are becoming more aware of the ramifications of nurse staffing issues, and as they endeavor to address them with legislative solutions, the decision on how best to develop optimal staffing strategies may soon be taken away from nursing leaders. To maintain control of this important issue and develop solutions that will help highlight the economic and patient care contributions of nurses, a thorough understanding of the problem, and a new commitment are needed from nursing leaders to take charge of the issue. To relate nursing care to patient outcomes, meaningful data on the nursing care provided is needed in addition to data on the nursing needs of patients. Staffing and performance monitoring tools should be used to effectively plan, implement, and control financial and operating resources as well as measure the economic value of the nursing profession's contribution to the cost and benefits of patient care.     

The CNO/CFO partnership: navigating the changing landscape

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.     

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.     

Building a case for using technology: health literacy and patient education

The interplay of a mobile population can affect the quality of patient outcomes and the economics of health care delivery significantly. Helping patients with limited English proficiency understand the basics of self-care for optimal health will continue to be a challenge in the delivery of the highest quality nursing care. Becoming familiar with high-quality, peer-reviewed, and reliable health education materials and Web sites is the responsibility of every health care provider so that patients receive culturally and linguistically appropriate resources to support healthy lifestyles and choices.     

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.     

Advanced practice nurse outcomes 1990-2008: a systematic review

Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs) are APRN patient outcomes of care similar? This systematic review of published literature between 1990 and 2008 on care provided by APRNs indicates patient outcomes of care provided by nurse practitioners and certified nurse midwives in collaboration with physicians are similar to and in some ways better than care provided by physicians alone for the populations and in the settings included. Use of clinical nurse specialists in acute care settings can reduce length of stay and cost of care for hospitalized patients. These results extend what is known about APRN outcomes from previous reviews by assessing all types of APRNs over a span of 18 years, using a systematic process with intentionally broad inclusion of outcomes, patient populations, and settings. The results indicate APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States, and could help to address concerns about whether care provided by APRNs can safely augment the physician supply to support reform efforts aimed at expanding access to care.     

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.     

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.     

Income distribution functions with disturbances

Recent exercises in the maximum likelihood estimation of income distribution functions provide goodness of fit tests which lead to the rejection of most models. This result is usually ignored on the ground that the test is too strict, since it allows for sampling variation only. If income distribution functions, like other econometric models, are not meant to hold exactly, we should introduce disturbances in the statistical model. Here we treat observed income as the sum of a systematic component with a specific two-parameter distribution — Pareto, Gamma, or Lognormal — and an independent normal error. The ensuing models fit conventional U.S. income data much better than their traditional counterparts, but they still fail a goodness of fit test.     

Estimating the time involved in managing the 'unoccupied bed:' a time and motion study

Occupied bed days are often used as a demand indicator when calculating the number of nurses required to provide safe care. However, such calculations fail to take into account the amount of nursing time consumed by the "unoccupied bed." This study used direct observation time-and-motion methods to estimate the time and costs associated with a bed that is unoccupied. The average time taken to complete all of the activities associated with a bed that was unoccupied due to an internal transfer was 8.65 minutes, for a patient discharge 26.27 minutes, and for a patient admission 37.7 minutes. An average daily cost for activities surrounding these patient movements was approximately $386/day (AUD) in registered/enrolled nursing salaries alone. The unoccupied bed is not resource neutral and time associated with its maintenance should be considered when calculating nursing requirements to provide safe care.     

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.     

Health services research in nursing: current status and future directions

To assess the current status of health services research in nursing, 113 studies reported between 1980 and 1989 were reviewed. Identified gaps in this research included comprehensive cost-benefit and cost-effectiveness analyses, effects of technology on patient care, evaluations of information systems, evaluations of innovative care delivery approaches, and studies of ethical issues related to the use of scarce resources.     

Streamlining regulatory compliance through clinical systems

The Joint Commission states that its mission is "to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.... Accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes" (JCAHO, 2003). The focus of JCAHO is not much different from that of every health care organization. Clinical information systems should be employed to help deliver safer, more efficient patient care, and at the same time ensure that health care organizations achieve regulatory compliance.     

Nursing informatics: an evolving specialty

Health care organizations will continue to invest heavily in clinical information systems to help improve patient safety, reduce variability of care, and increase the efficiency of their staff. These clinical information systems can assist in reducing medication errors through sophisticated medication management solutions and provide clinical decision support to aid in the decision making of all clinicians. They can also help offset the effects of a growing worker shortage, especially hard-felt in nursing, by reducing redundant tasks, improving communication, and streamlining clinical data collection. As these clinical systems are implemented, there is an increased need for information management of all of this complex data. By bringing both clinical and information systems expertise to bear, the informatics nurse plays a crucial role in ensuring that these goals are met to help the organization maximize its use of clinical information technology.$