The Iowa model: a proposed model for nursing administration

The purpose of the Iowa Model is to serve both as a heuristic device and as a framework for articulating knowledge for nursing administration research, practice, and education. The model delineates two domains of knowledge (systems and outcomes), each with three levels (patient aggregates, the organization, and the health care system). Concepts useful for knowledge development are identified for each level. Practice, research, and curricular applications of the model are made.     

Care planning efficiency for nursing facilities

The project reported here is the first in a series of cost analyses regarding the care planning process among 107 facilities. Process-based costing strategies and data envelopment analyses identified nursing facilities with efficient and less-efficient care planning processes. Having more people and more time devoted to the care planning process did not assure quality or efficiency. Efficiency varied across the nursing facilities and was not related to number of beds, profit status, or location; however, Medicare-certified facilities were less likely to be efficient.     

Building a nursing research fellowship in a community hospital

Often, registered nurses feel that they are using "evidence" to guide practice, but in reality the sources of evidence are not based on research. The nursing leadership team at Northwest Community Hospital was committed to integrating evidence-based practice and nursing research into the clinical setting for RNs at all levels of the organization. The scope of the fellowship program enabled direct care RNs to receive protected release time for a 12-month period to develop a research proposal, implement the study, and disseminate the findings. The Nursing Research Fellowship Program was successful from the perspective of the Magnet appraisers who recognized the program as a Magnet exemplar, the chief executive officer, the CNE, members of the nursing leadership team, professional colleagues, the fellows and partners, and registered nurses at all levels in the organization. Nursing research is now part of the professional nursing culture.     

Hospital staff shortage: the role of the competitiveness of pay of different groups of nursing staff on staff shortage

Shortages of nursing staff in OECD countries have been a preoccupation for policy makers. Shortages of staff may be the consequence of uncompetitive pay. In the private sector, employers in different regions can offer different pay rates to reflect local amenities and cost of living. Hospitals in the UK however cannot set the pay for their employees, and as a result they might therefore incur staff shortages. Moreover, occupational groups do not operate in isolation. Shortages of staff may also be the consequence of the competitiveness of pay of an alternative group of staff. This is investigated using two distinct groups of nursing staff: assistant nurses (ANs) and registered nurses (RNs) working in English hospitals in 2003–2005 using national-level data sets. We find that an increase by 10% of the pay competitiveness of RNs decreases the shortage of both the RNs and of ANs by 0.6% and 0.4%, respectively.     

A tool for fiscal policy planning in a medium-term fiscal framework: The FMM-MTFF model

This paper describes the FMM-MTFF model, a dynamic stochastic general equilibrium model developed to support the implementation of a Medium-Term Fiscal Framework (MTFF) in emerging market and developing economies. The model exhibits the following features. First, fiscal policy is defined in terms of multi-year fiscal plans, instead of restricting attention to univariate, single-period fiscal shocks. Second, the model temporarily deactivates the fiscal rule to avoid forcing fiscal policy to be mechanically countercyclical and sustainable. Third, the model is calibrated to match a three-sector, stylized version of a country’s input-output table, and finally, the model uses a chain-weighted procedure to measure GDP, a method consistent with what national account compilers do. The model is calibrated to Colombian and Peruvian data to illustrate the use of the model as a tool to quantify the scale of the fiscal challenges, to provide consistent medium-term macro fiscal projections and to assess the quantitative implications of past reforms and alternative fiscal policy plans on the economies, i.e., the typical questions of interest to an MTFF.     

End-of-life care in nursing homes: the high cost of staff turnover

Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.     

A price endogenous computable planning model for a dual economy

This paper examines the nature of linkages between growth, employment and functional distribution of income in a dual economy. The analysis is carried out in terms of a dual economy general equilibrium model which is implicitly based on a social accounting matrix (SAM) type of information system. The parameter values and the structure of the model are based on Iranian data and the selection of policy packages is inspired by those undertaken in Iran during the 1970s. The model sheds some light on the consequences of the policies by quantifying their potential impact on the sectoral growth of output, levels of employment and functional distribution of income in the rural and urban areas.     

Strategic planning for skills and simulation labs in colleges of nursing

While simulation laboratories for clinical nursing education are predicted to grow, budget cuts may threaten these programs. One of the ways to develop a new lab, as well as to keep an existing one on track, is to develop and regularly update a strategic plan. The process of planning not only helps keep the lab faculty and staff apprised of the challenges to be faced, but it also helps to keep senior level management engaged by reason of the need for their input and approval of the plan. The strategic planning documents drafted by those who supervised the development of the new building and Concepts Integration Labs (CILs) helped guide and orient faculty and other personnel hired to implement the plan and fulfill the vision. As the CILs strategic plan was formalized, the draft plans, including the SWOT analysis, were reviewed to provide historical perspective, stimulate discussion, and to make sure old or potential mistakes were not repeated.     

The effectiveness of community-based hospital planning: some recent evidence

The effectiveness of centralized or community-based local planning of hospital resources is still a subject for debate in most countries. The general problem of overcapitilization on beds and equipment has been reviewed in a number of theoretical (Granfield, 1975; Dahlberg 1976) and empirical studies (Cullis et al., 1980; Feldstein, 1967). Hospital planners frequently argue that the resulting direct benefits exceed the costs. The purpose of this paper is to estimate the impact of community-based hospital planning on controlling growth in the supply of beds and plant assets in the United States.     

The AACN Synergy Model for Patient Care: a nursing model as a Force of Magnetism

One of the 14 Forces of Magnetism requires a health care organization to have a professional model of care. The eligibility requirements stipulate that this model must be utilized throughout the health care system and that the same philosophy must be used throughout the system. The American Association of Critical-Care Nurses Synergy Model for Patient Care describes nursing practice based on eight patient characteristics, and also describes eight nurse competencies. The core concept of the model is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit, or system are matched with a nurse's competencies. The synergy model is an excellent framework to organize the work of patient care throughout the health care system. It can be used and applied in various ways and provides a comprehensive framework for assuring success in building a philosophy that supports the Forces of Magnetism.     

Localization of a demand for nursing model at the grassroots level

A major obstacle to the development of a usable demand model for nursing is the standardization of the definition for "demand." The lack of standardization of economic terms which are utilized in the state demand models is contributing to the failure of the long-range forecasting process for nursing nationwide. Any state that chooses to utilize U.S. Department of Health and Human Services' Health Resources and Services Administration data has selected a model which is invalid due to failure to include all members of the nursing population since this definition excludes LPNs completely. Likewise, state nursing demand models in California, Pennsylvania, North Dakota, New Jersey, and the District of Columbia have similar disadvantages. Only at a localized county-by-county grassroots level can a nursing demand model be translated into an equation which would actually calculate demand for nursing.     

A cost-analysis model for anticoagulant treatment in the hospital setting

Background:

Rivaroxaban is the first oral factor Xa inhibitor approved in the US to reduce the risk of stroke and blood clots among people with non-valvular atrial fibrillation, treat deep vein thrombosis (DVT), treat pulmonary embolism (PE), reduce the risk of recurrence of DVT and PE, and prevent DVT and PE after knee or hip replacement surgery. The objective of this study was to evaluate the costs from a hospital perspective of treating patients with rivaroxaban vs other anticoagulant agents across these five populations.

Methods:

An economic model was developed using treatment regimens from the ROCKET-AF, EINSTEIN-DVT and PE, and RECORD1-3 randomized clinical trials. The distribution of hospital admissions used in the model across the different populations was derived from the 2010 Healthcare Cost and Utilization Project database. The model compared total costs of anticoagulant treatment, monitoring, inpatient stay, and administration for patients receiving rivaroxaban vs other anticoagulant agents. The length of inpatient stay (LOS) was determined from the literature.

Results:

Across all populations, rivaroxaban was associated with an overall mean cost savings of $1520 per patient. The largest cost savings associated with rivaroxaban was observed in patients with DVT or PE ($6205 and $2742 per patient, respectively). The main driver of the cost savings resulted from the reduction in LOS associated with rivaroxaban, contributing to ～90% of the total savings. Furthermore, the overall mean anticoagulant treatment cost was lower for rivaroxaban vs the reference groups.

Limitations:

The distribution of patients across indications used in the model may not be generalizable to all hospitals, where practice patterns may vary, and average LOS cost may not reflect the actual reimbursements that hospitals received.

Conclusion:

From a hospital perspective, the use of rivaroxaban may be associated with cost savings when compared to other anticoagulant treatments due to lower drug cost and shorter LOS associated with rivaroxaban.     

A cross-impact model applicable to forecasts for long-range planning

A methodology is developed, which is based on cross-impact analysis and which is useful in estimating the effects of uncertainty in future sales programs and the effects of program interaction on long-range sales forecasts. The utility of the cross-impact methodology vis-a-vis the conventional decision-tree approach lies in the reduction of complexity made possible when a large number of programs must be considered.     

The Endogenous Sequential Probit model: An application to the demand for hospital utilization

This paper develops the Endogenous Sequential Probit model to analyze the effect of managed care on hospital utilization by adult married US population and finds that managed care gives disincentives to utilize hospital care relative to the standard indemnity plans.