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.     

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.     

INFRASTRUCTURE PROVISION,POLITICS AND RELIGION: INSIGHTS FROM TUNISIA'S NEW DEMOCRACY

This paper analyzes the relationship between access to infrastructure services and support for religious parties based on the evidence produced by a recent democratic experience in Tunisia in which a religious political party, Ennahdha, governed from 2011 to 2014. The experience points to a complex relationship. In the 2011 election, areas with higher access are associated with higher support for Ennahdha than areas with lower access. In the 2014 election, however, infrastructure access is positively correlated with support for the party in areas where access had improved but negatively correlated with support for the party in areas that already had high access. A possible pragmatic general implication is that, to be politically competitive, religious parties, cannot bet solely on their religious commitment to provide basic services, including infrastructure, to the poor. They need to recognize the multiplicity of voter's concerns and their evolving agenda.     

Is the shortage of hospital registered nurses getting better or worse? Findings from two recent national surveys of RNs

The results of two recent national surveys of RNs that were conducted at a time when the nursing shortage in the U.S. was in full force (2002) and 2 years later (2004) were compared. The findings provide a mixed assessment: on the one hand, there is evidence that the shortage has eased since 2002 and that there have been notable improvements in the lives of nurses; on the other hand, the shortage has had a negative impact on hospitals and nurses, and longstanding problems associated with the workplace environment remain.     

Specialized new graduate RN critical care orientation: retention and financial impact

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64%. he objectives of this study were to determine the retention and costs associated with the employment of new graduate RNs before and after the initiation of a specialized year-long critical care orientation program. Retention was compared between two independent groups of graduate RNs in the critical care units of two tertiary hospitals in a multi-hospital health care system in metropolitan New York. The major study findings were a significant difference in retention between the two groups at 3 months, 9 months, and 12 months, and an annual financial savings related to decreased nursing turnover. Specialized orientation programs that support new graduate RNs have documented increased retention and decreased turnover. Health care finances are positively impacted by specialized orientation programs.     

A tale of minorities: evidence on religious ethics and entrepreneurship

Does Protestantism favour entrepreneurship more than Catholicism does? We provide a novel way to answer this question by comparing Protestant and Catholic minorities using Swiss census data. Exploiting the strong adhesion of religious minorities to their denomination’ ethical principles and the historical determination of the geographical distribution of denominations across Swiss cantons, we find that Protestantism is associated with a significantly higher propensity for entrepreneurship. The estimated difference ranges between 1.5 and 3.2 % points, it is larger the smaller the size of the religious minority, it is mainly driven by prime age male entrepreneurs and it stands up to a number of robustness checks. No effects are found when comparing religious majorities, suggesting that the implications of religious ethical norms on economic outcomes emerge only when such norms are fully internalized.     

A consortium approach to nursing staff development

Within a consortium framework, four teaching hospitals have developed a curriculum for nursing staff development. Since 1980, the institutions have realized significant savings. The courses provide networking and integration of new research and facilitate technological transfer. Other institutions may also find a collaborative approach beneficial.     

Journey to Magnet: cost vs. benefits

As hospitals and health systems strive to be an "Employer of Choice", one important goal for their nursing leaders has been the decision to embark on their journey of becoming a designated Magnet facility. Approximately 12 months ago, conversations with a few chief nursing executives uncovered a hot topic concerning the achievement/designation of Magnet status and specifically its cost benefits. With more and more hospitals obtaining Magnet status, these nurse leaders did not know how other organizations felt about their journey including outcomes and were very interested in learning more details about their colleagues' experiences.     

The effect of physician board membership on uncompensated care provision

Previous studies indicate that nonprofit and for-profit hospitals provide comparable levels of uncompensated care, when taking into account their sizes. This evidence suggests that for-profit hospitals extract some indirect benefit when providing uncompensated care. Our article investigates how physician board membership affects uncompensated care provision. With data for hospitals in California from 1997 to 2010, we estimate a fixed-effect model where uncompensated care is a function of physician board membership, other board attributes, as well as hospital characteristics. Our results indicate that physician board membership in for-profit hospitals relates positively with uncompensated care provision. Prior evidence, such as Goldstein and Ward (2004) and Molinari et al. (1995), has shown that involving physicians in strategic decisions improves hospitals’ financial performance. Our results reinforce the notion that having physicians in leadership or strategic positions benefits for-profit hospitals. In these hospitals, physicians seem to understand the strategic component of providing uncompensated care, possibly due to their closer assessment of patients’ needs.     

Investigating productivity change and hospital size: a nonparametric frontier approach

The study obtains measures of the productive efficiency of ‘larger’ and ‘smaller’ Northern Ireland hospitals during the 1986–92 pre-Trust period. The measures provide insights into how these hospitals were responding to the pressures for increased efficiency prior to Trust status. They also constitute a useful benchmark for evaluating productivity change under the post-1992 Trust status environment. A nonparametric frontier approach is used to measure productivity change and to decompose this into technical change (or shifts in the best practice frontier) and efficiency change (or change in how far a hospital is from the frontier). The latter change in efficiency is also decomposed into changes in scale efficiency, pure technical efficiency and input congestion. The findings indicate that smaller hospitals, starting from a less efficient base, achieved greater productivity gains than larger hospitals over 1986–92. For smaller hospitals, this was due to progressive shifts in the best practice frontier outweighing a substantial decline in efficiency. This decline was found to be due to a deterioration in scale efficiency over the period. The results overall support the current policy view that larger hospitals are more efficient than smaller hospitals in providing health care services.     

Managerial rewards and the behavior of for-profit,governmental, and nonprofit organizations: evidence from the hospital industry

Studies of mixed industries frequently focus on differential behavior between for-profit and either nonprofit or governmental producers. Substantially less is known about differences among governmental, religious nonprofit, and secular nonprofit organizations. We examine the compensation of hospital CEOs to assess the extent to which these three organizational forms pursue similar objectives. Compensation levels, the use of salaries versus bonuses as proxies for weak versus strong incentives, and the criteria organizations use to determine bonuses are analyzed. We conclude that the CEO incentive contracts at religious nonprofit, secular nonprofit, and governmental hospitals imply substantive differences in the behavior of these organizations.     

Trust in the image of God: Links between religiosity and reciprocity in Haiti

Are religious believers more prosocial than other people? In a trust game field experiment with 774 subjects in Haiti, we elicit willingness to pay to play in the presence of religious images, and argue that this can be interpreted as a measure of the strength of religiosity. More religious individuals trust others more and reciprocate more than others, with effect sizes between 14% and 21% of mean behaviour depending on the measure. They do not reciprocate more in the presence of religious images than without them, nor towards members of the same denomination as themselves. The results support the view that religious affiliation is correlated with intrinsic trustworthiness. We show that lab behaviour correlates with intuitive measures of religiosity outside the lab and with participation in borrowing and lending networks.     

Preventing Islamic radicalization: Experimental evidence on anti-social behavior

Social tensions and violence induced by radicalized Muslims afflict many parts of the world. We collaborated with the main Islamic authority in Mozambique, which sponsored two randomized interventions to prevent violence related to youth radicalization: a religious campaign against extremist views of Islam, targeting change in beliefs; and a training module on entrepreneurship and employment, aiming to increase the opportunity cost of conflict. Our measurement focuses on anti-social behavior in a Joy-of-destruction lab game. We find that only the religious treatment decreased the propensity to destroy the payoffs of others. Consistently, surveys show increased trust in the state and decreased support for extremism. We conclude that religious sensitization is likely to be cost-effective in preventing Islamic radicalization and anti-social behavior.     

Hospital nursing costs, billing, and reimbursement

Nursing intensity, estimated direct nursing costs, and daily billing were compared for 12 adult medical or surgical units at an academic medical center from January 1 to May 31, 2005 (22,649 patient days). Two main findings, nursing intensity and direct nursing costs, were highly variable within and across each of the study nursing units (mean 429 dollars, SD 160 dollars); direct costs of nursing care were significantly higher for private room rates compared to intermediate room per diem charges billed at a higher rate (441 dollars vs. 426 dollars, F 37.77, p < 0.001). The results demonstrate that the direct costs of nursing care are not aligned with current billing practices at this university hospital. The use of fixed room and board charges to account for nursing care in U.S. hospitals may be obsolete and an alternative nurse-centric costing, billing, and reimbursement model is proposed.     

The potential imposition of wage controls on nurses: a threat to nurses, patients, and hospitals

When there are shortages of RNs, hospitals and health care organizations in competitive nurse labor markets respond by increasing wages: some hospitals will respond faster and some will offer higher wages than others. The wage increase brings about two important short and long-run outcomes that, together, will increase the supply of RNs in the labor market. Because wage controls prevent the flexibility of wages to adjust, they can cause a shortage to develop when the demand for RNs is increasing (as in the 1970s), and wage controls will lengthen the duration of a shortage once it has begun. The impacts of prolonged RN shortages are multifaceted and destructive to nurses, patients, and hospitals. Looking ahead over the next 15 years when the demand for RNs is expected to grow by roughly 3% per year and the supply of RNs by much less than that, a new nursing shortage is projected to develop and reach a deficit of 285,000 RNs by 2020. The worst thing that could happen to the nursing profession would be to impose wage controls on nurses as this would prevent the needed short and long-run labor supply responses from developing and thereby eliminate the shortage.     

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.     

The direct medical costs of Huntington’s disease by stage. A retrospective commercial and Medicaid claims data analysis

Abstract

Objective:

This study quantified the direct healthcare costs and major cost drivers among patients with Huntington’s disease (HD), by disease stage in commercial and Medicaid databases.

Methods:

This retrospective database analysis used healthcare utilization/cost data for HD patients (ICD-9-CM 333.4) from Thomson Reuters’ MarketScan Commercial and Medicaid 2002–2009 databases. Patients were classified by disease stage (Early/Middle/Late) by a hierarchical assessment of markers of disease severity, confirmed by literature review and key opinion leader input. Costs were measured over the follow-up time of each patient with total costs per patient per stage annualized using a patient-year cost approach.

Results:

Among 1272 HD patients, the mean age was similar in commercial (752 patients) and Medicaid (520 patients) populations (48.5 years (SD?=?13.3) and 49.3 years (SD?=?17.2), respectively). Commercial patients were evenly distributed by stage (30.5%/35.5%/34.0%; Early/Middle/Late). However, most (74.0%) Medicaid HD patients were classified as Late stage. The mean total annualized cost per patient increased by stage (commercial: $4947 (SD?=?$6040)–$22,582 (SD?=?$39,028); Medicaid: $3257 (SD?=?$5670)–$37,495 (SD?=?$27,111). Outpatient costs were the primary healthcare cost component. The vast majority (73.8%) of Medicaid Late stage patients received nursing home care and the majority (54.6%) of Medicaid Late stage costs were associated with nursing home care. In comparison, only 40.6% of commercial Late stage patients received nursing home care, which contributed to only 4.6% of commercial Late stage costs.

Conclusions:

The annual direct economic burden of HD is substantial and increased with disease progression. More late stage Medicaid HD patients were in nursing homes and for a longer time than their commercial counterparts, reflected by their higher costs (suggesting greater disease severity). Key limitations include the classification of patients into a single stage, as well as a lack of visibility into full long-term care/nursing home-related costs for commercial patients.     

When nurses terminate: the exit interview/questionnaire

Reliable information on termination issues can enhance retention and recruitment efforts. Blank nursing exit questionnaire/interview forms from 49 hospitals were analyzed. A sample exit questionnaire and recommendations for the collection of data regarding the departing nurse are provided.     

The internal market and hospital efficiency: a stochastic distance function approach

The UK internal market was one of the first European attempts to introduce a competitive mechanism in the provision of hospital services. The assumption was that competition would have led hospitals to increase efficiency in the use of their resources. The aim of this paper is to analyse the effectiveness of this kind of reform by measuring the changes in technical efficiency of a panel of 52 acute Scottish hospitals observed from 1991/92 to 1996/97. The time period covers the whole duration of the internal market and the sample contains a different mix of both trusts and non-trusts, where the former embed the proper working of the reform. The selected model is a stochastic output distance function that includes an interaction dummy variable to allow for parameters to change over time. The results show a structural break after which hospitals change not only the way in which they provide their services, but also the kind of services they provide, favouring the quicker treatment of patients on a day basis. No significant improvement in technical efficiency is detected instead over time, nor any significant difference in efficiency between trusts and non-trusts.     

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.