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 recession's effect on hospital registered nurse employment growth

Recessions are not uncommon in the United States, but the most recent recession is arguably the most severe economic downturn since the Great Depression of the 1930s. Although recessions result in increases in national unemployment in most sectors of the economy, they have resulted in increases in registered nurse (RN) employment as many non-working married RNs re-enter the workforce when their spouses lose their jobs. Over the past decade, hospital RN employment increased by more than 400,000 with virtually all of this growth associated with the two recessions that occurred during this period. The most recent recession led to an increase in hospital RN employment that was not only unprecedented in size, estimated at nearly 250,000, but was marked by the employment of large numbers of RNs over 50 years of age. While national unemployment rates remain high, hospitals should prepare for an eventual jobs recovery when many RNs are likely to leave the workforce.     

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.     

Evolution of the chronic care role of the registered nurse in primary care

High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.     

The California Nurse Mentor Project: every nurse deserves a mentor

In the rush to fill positions, newly hired and transitioning RNs are increasingly put into demanding roles without adequate clinical or organizational preparation. One approach that has shown promising preliminary success in enhancing nursing job satisfaction and increasing long-term retention is the use of trained nurse mentors who are paired with newly hired or new graduate nurses to provide ongoing support, guidance, and assistance. The California Nurse Mentor Project was a 3-year pilot project whose goal was to create a replicable program designed to improve the quality, sensitivity, and effectiveness of patient care through enhanced retention of nurses, including multicultural, multilingual, and male nurses. The pilot implementation of the California Nurse Mentor project has been extremely successful. Attrition rates are lower for nurses who are enrolled in the program than those who did not. Both mentors and mentees report that the program has impacted several areas, including their job satisfaction and professional confidence. Preceptor training, according to participant feedback, shows lasting effects on their pedagogy even a year after attending the training.     

区域发展规划中建设用地需求量预测研究

以大连花园口经济区及周边区域为评价区,以土地可持续利用理论为依据,应用土地生态适宜性评价方法,在GIS技术（MapInfo7.0）的支持下,基于公里网格,选择地形地貌、土地利用现状两大因子为评价指标,对大连花园口经济区及周边建设用地适宜性进行综合评价,旨在为合理有效地安排土地资源的用途提供科学依据。评价结果表明：大连花园口经济区及周边最适宜、较适宜、基本适宜、勉强适宜建设用地面积分别为35 145.60、13 651.97、19 001.93、7 540.04hm2,分别占评价区总面积的46.65%、18.12%、25.22%、10.01%。通过对大连花园口经济区及周边建设用地适宜性评价,从而推测出该区域发展规划中对建设用地的需求量。     

American Academy of Ambulatory Care Nursing position statement: the role of the registered nurse in ambulatory care

Ambulatory care nurses are leaders in their practice settings and across the continuum of care. They are uniquely qualified to influence organizational standards related to patient safety and care delivery in the ambulatory care setting. The current ambulatory care setting is diverse and multifaceted, requiring nurses highly skilled in patient assessment and with the ability to implement a broad range of nursing interventions in a variety of settings. The future of the American health care system depends upon our ability to utilize RNs to the fullest extent of their expertise, licensure, and certification.     

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.     

Nurses who do not nurse: factors that predict non-nursing work in the U.S. registered nursing labor market

Registered nurses (RNs) who work outside of nursing have seldom been examined. This aim of this study was to compare the 122,178 (4%) of RNs who are employed outside of nursing to those who work in nursing jobs in terms of sociodemographic, market, and political variables to determine if these groups are substantively different from one another. Using a logit regression model, wages were a significant predictor of working outside of nursing for unmarried nurses but not for married nurses. Married and unmarried male nurses were more likely to work outside of nursing. Baccalaureate education, children under age 6, higher family income, and years since graduation increased the odds of working outside of nursing for married nurses. Ultimately, identifying characteristics on which these groups differ may inform future policy directions that could target nurses who may leave nursing at a time when retention efforts might be effective to alter their trajectory away from the profession.     

Why a well-paid nurse is a better nurse

In an article subtitled "Why is a Badly Paid Nurse a Good Nurse?" economist Anthony Heyes argues that nursing wages should be kept low. Counter arguments are provided based on what the authors consider more adequate economic analysis.     

The effect of workforce issues on patient safety

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.     

An educational loan repayment program for registered nurses

A state-sponsored loan repayment program offers nurse executives a unique and highly effective recruitment and retention strategy while providing financial assistance to professional nurses repaying educational loans.     

A contribution to forecast theory

The overall basis of forecasting can be stated as a relation between the projection of the known values of the present and the uncertainty of the future. Information and uncertainty factors have been quantified by the “choice of alternatives” concept used in information theory. There is a strong analogy between information theory and the sum of squares equations used in regression. The regression equations can also be expressed in terms of information and uncertainty. The analogy is used as a background explanation for the relation between the length of the backcast and the confidence in the forecast. The relation is shown by the loss of confidence in the standard interval at the mean of the backcast time to the interval at forecast time. Confidence curves and tables are shown for the normal and t distributions using the 90% confidence interval as projected to various future times. Other intervals can be computed by changing the t value. The last part is a brief discussion of confidence envelopes for three and four dimensions.