The language of business: a key nurse executive competency

The ability to interpret fiscal data pertaining to patient outcomes, human resources, customer satisfaction, and financial positions is a vital evidenced-based nurse executive competency. The ability of nurse leaders to influence and contribute in health system executive decision making requires fluency in accounting, "the language of business." After examining challenges faced by nurse executives, faculty at the Loewenberg School of Nursing at the University of Memphis integrated intensive accounting education into a new executive MSN program. Woven throughout the management accounting course is the concept that accounting data must be relevant and accurate for use by organization decision makers. Evidence-based decision making is emphasized when teaching planning and control activities. In addition, fluency in accounting is enhanced which leads to greater skill in patient and nursing advocacy. As competency in management accounting increases through the semester, executive MSN students are encouraged to apply cost accounting course content to their practice settings and to analyze how planning or control activities improve quality outcomes.     

Building a patient-focused unit: the nurse manager's challenge

Developing a patient-focused unit is necessary to attain the highest standards of patient care. It is only when we can view our unit through the eyes of a patient that we will be able to see ourselves as others see us. Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused.     

Validating HRSA's nurse supply and demand models: a state-level perspective

In addition to federal initiatives, solutions to the nursing shortage must also be devised at the state level. Understanding the timing and severity of the nursing shortage in a particular state is paramount to devising appropriate solutions In 2005, the Health Resources and Services Administration released new versions of the Nurse Supply Model and Nurse Demand Model designed to project the supply of RNs and demand for RNs, LPNs, and nurse aides in the United States through the year 2020. The process used by two state-level analysts to project nurse supply and demand in North Carolina using the HRSA models is described. The authors conclude that the models work well for state-level forecasting but that users should carefully assess the default data provided with the model against independent data sources specific to their states.     

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.     

Work satisfaction among California registered nurses: a longitudinal comparative analysis

California's minimum nurse-to-patient staffing ratio law, the nation's first, was implemented in 2004. This study had two aims: (a) to evaluate the effect of the nurse-to-patient ratios law on nurse job satisfaction in order to advance the debate over the merits of nurse staffing law, and (b) to compare California nurses who were satisfied against those who were not, in order to facilitate the development targeted retention interventions based on empirical evidence. The sample's overall job satisfaction increased significantly as the years passed, suggesting the nurse-to-patient ratios law was associated with improvements in nurse satisfaction. Satisfied RNs were more likely to have a balanced and financially secure life that included a partner, children living at home, higher hourly wages, and higher income from sources other than a nursing job. Nurses working in direct patient care positions remained dissatisfied in larger proportions than those working in other types of positions, even after the nurse-to-patient ratios were implemented. More nurses are satisfied today than before the ratios; nevertheless, far too many nurses (18.5%) have job satisfaction scores that are neutral or worse.     

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.     

The effect of distance on willingness to pay values: a case study of wetlands and salmon in California

Most contingent valuation studies in the literature utilized a pre-determined geographic market area for their sample frame. In other words, they did not include variables that would measure the extent of the geographic areas over which to aggregate willingness to pay. These studies implicitly assumed that the effects of geographic distance were moot; an assumption that could have led to an understatement of the aggregate benefit values computed in these studies. The overall goal of this study was to determine if distance affects willingness to pay for public goods with large non-use values. The data used came from a contingent valuation study regarding the San Joaquin Valley, CA. Respondents were asked about their willingness to pay (WTP) for three proposed programs designed to reduce various environmental problems in the Valley. A logit model was used to examine the effects of geographic distance on respondents' willingness to pay for each of the three programs. Results indicate that distance affected WTP for two of the three programs (wetlands habitat and wildlife, and the wildlife contamination control programs). We calculate the underestimate in benefits if the geographic extent of the public good market is arbitrarily limited to one political jurisdiction.     

Guaranteed return regulation: a case study of regulation of water in California

Price cap regulation (PCR) arose out of dissatisfaction with rate-of-return regulation (ROR). In energy and water there has been a move away from PCR into an extended form of ROR, referred to as guaranteed return regulation (GRR). It is employed to implement policies that legislators are unwilling to apply by transparent methods, namely taxation, but willing to apply opaquely through the regulatory process. GRR does not promote efficiency and, as the California experience shows, the guarantees it provides are limited. Its success in California has been mixed and it should be considered to be a work in progress and open to improvements, some of which are outlined.     

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.     

循环经济:从理想到现实的系统工程

从传统工业经济向循环经济转型,不仅意味着经济形态的转变,更意味着社会与文化形态的深刻变革。物质技术层面为循环经济的发展构筑了物化平台和技术层面的可能性;制度行为层面为循环经济的发展提供了社会运作的制度框架;从传统工业文明向生态文明的转型触及传统工业文明的精神内核,是保障循环经济良性发展的社会依托。