Pieces of the shortage puzzle: aging and shift work

Addressing issues important to the aging nurse and night-shift worker is imperative for retention success. It is important for nurse leaders to create an environment that will keep older nurses and night-shift workers working. The good news is that health care leaders are talking. Research is being done and will hopefully continue. Now it is time for health care leaders to welcome nurses, educators, and policymakers into their circle of discussion to preserve quality health care and retain our nurses at the bedside.     

身份与信任*——基于干部身份的实验证据

本文设计了由中国大学生被试作为委托人和受托人的投资实验,通过在实验中“泄露”不同完备和对称程度的信息,检验了在“无信息”、“单向信息”和“双向信息”三种不同的环境下,“学生干部”这一社会身份对“信任”和“值得信任”水平的影响。研究发现：首先,多数中国学生被试之间存在着彼此信任和值得信任,这使得双方实现了“双赢”。其次,受托人的干部身份,招致了委托人更高的可信任度;但干部在其身份信息不公开时,并不比无信息状态下的受托人更值得信任。再次,双向信息的干部身份可以显著提升干部的互利性,使得他们比无信息状态下的受托人有着更高的值得信任的水平。     

TIQ (Technical IQ)--a survival skill for the new millennium

Managing in the new technocracy of the new millennium will be challenging but also much more exciting than the work we do now. Twenty years ago, nurse managers weren't held accountable for the level of knowledge about financial outcomes that is expected now. The same will be true for technology. With electronic medical records, innovations in medical treatments, and the impact of the information and technologic revolution on the entire world, the interface between technology assessment, operationalizing technology, and continually upgrading staff to know what the implications of the technology revolution are will be imperative for success. That means that we must influence schools of nursing to include technology in their content now, and to help us prepare this generation of health care leaders to take a full seat at the leadership table to manage these complexities in the future. The success of the leader of the future will be measured by that person's ability to integrate the very complex issues of patient care and technology in a way that makes sense for patients, the organization, and the staff who will be working in a very complex environment. The leader's TIQ will be as important as other intelligences in the next 20 years.     

The art of leading with grace

Uncivilized environments take their toll on people who work there. Cultures of distrust are created and there is no warmth, reverence, or love available for the healing work of health care. We can blame the staff, or we can look at ourselves and recognize that the staff is merely a reflection of ourselves. Gracious leaders create a gracious and loving staff who care for patients and their families in extraordinary ways.     

When caring stops, staffing doesn't really matter

How well do we understand the people side of staffing, and do we recognize the importance therein? Delivering care without caring is simply wrong. Health care leaders must take this concern seriously and find ways to invest in and set up structures that support healthy processing, by individual caregivers, of the many emotional situations that are a natural part of care delivery. Individual care provides must take responsibility for their own well-being and make choices that promote self-care. We must find more ways to recognize and address the needs of care providers who are facing emotional burnout or compassion fatigue, as they are both a threat to their own health and a potential risk to the patients and organizations they serve.     

The new millennium and leadership: evolution or entropy?

Health care in the new millennium will be different. We have a wonderful opportunity to live in a new paradigm of leadership and management that opens up myriad possibilities for innovations in health care and leadership. If leaders stand still and don't quickly adapt to the new demands, they will be killed as leaders in this new millennium. The next 20 years are only for those who can act and adapt quickly.     

Leadership effectiveness: how do you measure up?

The purpose of this article is to provide leaders with a tool to collect accurate data of subordinate's perceptions. Leaders in the nursing profession must feel comfortable and be encouraged to seek the opinion of the staff they serve. Without actively seeking the feedback of subordinates there is no opportunity for personal growth and insight. So, while asking for staff feedback can be a "daring adventure" for any leader, leading staff who do not want to follow will result in an organization of "nothing" in today's health care arena.     

Palliative care: a paradigm of care responsive to the demands for health care reform in America

Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.     

Nurses leading the response to the crisis of palliative care for vulnerable populations

All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.     

Effects of female labour force attachment on health in Australia

This study examines the impact of female labour force attachment on health in Australia, where health care is socially provided. Longitudinal panel data from Women’s Health Australia is used in a metric analysis to capture the impact of labour market attachment on the physical component health score of relatively young and older female workers. After controlling for the healthy worker effect – wherein firms hire and retain the healthiest workers – and other health‐related changes in socio‐economic status, the analysis suggests that even a moderate attachment to the paid labour force has benevolent effects on health relative to no or marginal attachment. Given the existing social structure in Australia, remunerative work generally appears to enhance the health of young women and arrest the decline of health for older female workers.     

Leaders and windshields: the art of deflecting essential information

Do you know how much information you deflect in a day? Do you know what techniques you use to keep information at bay? We all erect windshields. It is just a matter of degree. Sometimes we deflect information in spite of our good intentions. If we are not present when people are in dialogue with us, we soon lose the attention of that person. If we are leading a meeting and the feedback begins to get uncomfortable for us, we can interject the techniques of the alpha male or alpha female, or a variety of our own. But the audience knows you are not listening, and they soon go underground with their comments and interpretations. Soon you are cut out of valuable feedback. Deflecting information by surrounding yourself with windshields just won't work. We need second and third opinions continually. One of Warren Bennis' (2002) ten traits to becoming a "tomorrow leader" is that of ensuring that the leader's boundaries are porous and permeable. In his view, leaders need the foresight to see around the corner long before others do. His belief is that the only way to do this is to be in touch with your customers, and the outside world. But that only happens when the leader's boundaries are porous and permeable so that information can seep in. Effective leaders learn to lead without windshields.     

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.     

Next generation workforce

The health care industry has become a very complex business. CQsts are rising and resources such as funding and human capital are diminishing. Human capital resources are about to reach true crisis proportions. The vital workforce we have counted on is expected to begin thinning as large numbers of Boomers retire. Not only does this deplete the workforce from a pure numbers perspective, but it also affects intellectual capital and institutional memory. Generational trends and characteristics have affected the workforce environment and will continue to do so as another generation continues to enter the workforce. Generation Y, also tagged Nexter, offers core values that can bring positive changes to the health care workforce. Technology continues to change at lightning speed. Embracing new technology and using it to refine the way we do business will help deliver success. Meaningful strategic plans are needed to change the model of business delivery and employee care in our future workforce.     

Courage, leadership, and end-of-life care: when courage counts

As leaders, we must feel a sense of moral obligation to implement evidence about end-of-life care in our practice setting. Nurse leaders can help patients and families orchestrate a beautiful experience that is an alternative to futile, expensive end-of-life care. Preparation is key in helping staff provide the best level of care. A plan built around the best care for patients can integrate with many diverse positions and people. Courageous nurse leaders are well adapted to maneuvering through political traps and advocating for patients and their families. Everyone benefits personally and financially, including our communities and nation, when courageous leaders advocate successfully for effective end-of-life care.     

Engaging patients and families in ehealth

National Health IT Week, which ran from September 11-16, 2011, served as a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States. During the week, the health IT community came together to raise national awareness regarding the consistent breakthroughs and hard work industry professionals, providers, and consumers have put forward to ensure they are moving toward the common goal of advancing the future of health care through private and secure health IT. Two events during the week (the Consumer Health IT Summit and the launch of the HealthlT.gov web site) brought home a theme increasingly seen as important to improving our health care system--patients participation in their care. Nurses will need to work with patients so they understand the importance of their participation as a partner in their care, instead of playing a passive role. One way we can do that is to encourage our patients to actively use technology to manage their own health care and to share information with their health care providers.     

Can a Mixed Health Care System be Desirable on Equity Grounds?*

Should health care provision be public, private, or both? We consider this question in a setting where people differ in their earnings capacity and face some illness risk. We assume that illness reduces an individual's time endowment when waiting for treatment. Treatment can be obtained in a competitive private sector (through private insurance) or in the National Health Service (NHS) where it is provided free of charge but after some (endogenous) waiting time. The equilibrium in the health care sector consists of a waiting time in the NHS such that no patient wants to switch health care provider. This equilibrium is governed by two public policies: the income tax system and the size of the NHS. We find that: (i) a mixed system with a small NHS is never desirable; (ii) actuarially fair sickness insurance is never desirable either; (iii) a mixed system with a sufficiently large NHS may improve on a pure public system if the dispersion of earnings capacities is large enough; and (iv) the welfare gains from such a mixed system are not likely to be significant.     

Stern measures

Andy Stern, new head of the Service Employees International Union, has set his sights on the nation's health care industry, linking workers' rights with consumer protection. The union's strategy is on display in California, where managed care has made dramatic inroads and financially pinched hospitals are shedding workers.     

The future of the Affordable Care Act: will we abandon health care reform?

With obstacles to the Affordable Care Act (ACA) growing, nurses need to continue to educate themselves about the ACA and the issues it is designed to address. While it has many shortcomings, the ACA invests in creating a new infrastructure that holds the potential to improve care quality and contain costs. Health economist Victor Fuchs suggests three areas must change if we are to have a health care system that is quality focused: information, infrastructure, and incentives. The current health care legislation is noble and lays a basis for future structural cost containment. The health care system continues to unravel as our politicians remain polarized over reform efforts. We must engage or we will never find solutions, never see reform.     

可占有能力下竞合联盟知识演化策略

在竞合联盟中,成员专有知识共享和保护是理论界研究的热点问题,中国宽松的产权制度背景可能使得这一问题变得既复杂又具有特殊性。以可占有能力这一隐性传输壁垒为出发点,构建龙头企业和追随企业的异质性决策演化博弈模型,探寻可占有能力如何影响不同成员的知识演化策略。研究发现：①领导企业和追随企业的知识策略表现出一定差异,当可占有能力达到阈值后,领导企业一定会选择知识共享策略,而追随企业的知识策略并没有出现均衡状态,其中,成果可占有能力对策略演化的作用效果比知识可占有能力强;②当联盟成员均采取知识共享策略时,无论是知识可占有能力还是成果可占有能力,均与联盟研发投入正相关。当联盟成员均采取知识保护策略时,无论是领导企业还是追随企业,研发投入仅与知识可占有能力正相关,而与成果可占有能力不存在任何关系;③不论采取何种知识策略,联盟成员的期望收益始终与成果可占有能力正相关,而与知识可占有能力负相关,且当可占有能力达到阈值时,成果可占有能力对企业期望收益的作用效果显著强于知识可占有能力。因此,在当前产权制度背景下,可以从提高自身可占有能力这一途径维护竞合联盟稳定性,以此作为宽松产权制度下的一个有效补充。