Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support.     

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.     

组织中的领地性研究:文献评述与研究展望

自Brown等将领地性概念引入组织管理领域以来,至今已有十余年,但到目前为止,领地性议题尚未引起学界广泛关注。在回顾国内外现有文献的基础上,对领地性概念的延伸与对比、量表发展,以及领地行为的前因与后果变量进行了梳理,展望了未来的研究方向,以为本土化理论构建提供崭新视角与实践指导。     

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.     

Professional role clarity and competency in health care staffing--the missing pieces

Professional role clarity and role competency are the missing pieces to achieving staffing excellence. The relationships among professional practice models, professional role competency, professional role clarity, patient safety, data, and staffing effectiveness build a solid equation, which supports improved patient outcomes. An essential variable binding these elements is housed in the patient handover conversation. Ensuring this handover is an evidence-based, data-driven conversation which contains both the medical and nursing plans of care provides standardization in nursing practice and improves patient safety. This powerful equation resets the nursing standard of practice and identifies the missing pieces to staffing excellence, namely, the integration of professional role clarity and professional role competency.     

Enculturation of professional contract nurses: a concept analysis

The concept enculturation, an essential component of integration into the work arrangement of professional contract nurses, also known as travel nurses, is analyzed. These registered nurses are contracted by hospitals through health care staffing service firms, for temporary work assignments. The work of travel RNs involves frequent recurring episodes of integration to health care teams at hospitals throughout the nation. Rodgers Evolutionary Method (Rodgers & Knafl, 2000) is applied to analyze the concept of enculturation, leading to a pragmatic perspective on its meaning and utility. This work may contribute new knowledge applicable to future nursing research.     

基于知识图谱的团队断裂带与创新：热点及趋势分析

团队断裂带基于团队整合与协同理念,考虑团队成员多重特征,丰富了团队属性的研究。其概念自1998年提出后,受到了广泛关注。探讨团队断裂带与创新的关系,从中国知网（CNKI）和 Web of Science数据库中选取“团队断裂带”为关键词,运用Citespace Ⅲ软件,进行知识计量图谱分析和信息挖掘。在此基础上,对相关文献进行梳理与总结,探究团队断裂带与创新的关系,从不同侧面探究了两者之间的作用机制。团队断裂带已经被分解出不同类型,需要更多的强度计算方法,分析断裂带宽度计算方法对创新的影响。通过构建团队断裂带与创新关系的研究框架模型,总结现有研究的脉络,进而指出现有研究的不足与未来研究方向。     

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.     

Capacity planning in hospital nursing: a model for minimum staff calculation

An aging population, emerging technology, heightening patient expectations, rising health care costs, shorter patient stays, and growing pressure to improve quality have made the management of nursing resources even more critical today. While approaching a model for staffing levels, the authors considered factors such as patient acuity, work redesign, and minimum quality standards. The methodology for analysis included estimating the time needed to complete nursing tasks and calculating the average number of tasks per patient. With respect to nursing quality measures, the study examined the adequacy of nursing documentation including admission history, assessments, nursing procedures, and discharge report as well as nursing-driven outcomes such as fall and phlebitis rates. Lastly, the authors determined the theoretical number of staff needed to provide nursing care according to quality standards.     

Can capacity markets be designed by democracy?

In the United States, Regional Transmission Organizations (RTOs) operate the power grid serving nearly 70% of electricity customers and are critical organizations for ensuring reliable system operations and facilitating the integration of new technologies and market participants. RTOs are designed to be stakeholder-driven organizations, with rules and policies crafted through a highly participatory process. While the decisions that RTOs make have implications for industry, society and the environment, their decision processes have not been modeled in any systematic way. In this paper, we develop a modeling framework for the stakeholder process of PJM, an RTO serving thirteen states plus the District of Columbia, adapting some of the seminal literature from political science and political economy on the theory of voting systems. This modeling framework can generate predictions of stakeholder process outcomes, identify strong coalitions among stakeholders and identify shifts in political power in the formulation of RTO market rules. We illustrate this analysis framework using a detailed data set from stakeholder deliberations of capacity market reform in PJM. Our model predicts that the current structure of the stakeholder process in PJM makes the passage of capacity market reforms through the stakeholder process virtually impossible because it creates strong coalitions that would favor or oppose changes to capacity market rules. In the capacity market case, we also identify a small subset of voters that act as swing voters and confirm that political power is shifted to these voters by deviations from otherwise strong coalitions and abstentions from the voting process altogether. Our framework represents the first attempt to model the decision-making behavior of RTOs in any systematic way, and points towards emerging research needs in evaluating the governance structure of RTOs.     

Variable temptations and black mark reputations

Reputations often guide sequential decisions to trust and to reward trust. We consider situations where each player is randomly matched with a partner in every period. One player – the truster – decides whether to trust. If trusted, the other player – the temptee – has a temptation to betray. The strength of temptation, private information to the temptee, varies across encounters. Betrayals are recorded as publicly known black marks. First, we identify equilibria when players only condition on the number of a temptee's black marks. Second, we show that conditioning on the number of interactions as well as on the number of black marks does not prolong trust. Third, we examine stochastic variations where black marks may be forgotten. Perhaps surprisingly, such variations do not improve outcomes. Fourth, when players condition on more general summary statistics of a temptee's past, we study equilibria where trust is suspended temporarily.     

Evidence-based staffing: potential roles for informatics

Over the last 15 years, evidence has been accumulating relating higher levels of nurse staffing in both quantity and experience to lower rates of adverse patient outcomes. Consequently, to promote quality patient outcomes efficiently, making staffing decisions based in evidence is of increasing importance. However, there is still limited data to help decide how to effectively allocate scarce nurse resources in practice. Existing principles, frameworks, and guidelines provide a foundation for nurse staffing decisions but face poor adoption. To determine optimal nurse staffing practices and provide evidence-based recommendations for policy, and integration into operations, comprehensive data are necessary. Information technology can assist nurse staffing decisions. Four informatics processes that may support evidence-based nurse staffing are described: (a) Data acquisition from multiple data sources, (b) Representation of data in a way it can be re-used for multiple purposes, (c) Sophisticated data processing and mining, and (d) Presentation of data in standardized and user-configurable ways.     

组织惯性:理论评述与研究框架构建

自20世纪80年代以来,组织惯性已经成为战略管理研究的重要内容。目前学术界对该概念的理解仍然存在较大差异,不利于后续研究和组织惯性理论的进一步发展。首先,基于国内外组织惯性文献的内容分析,将文献按照组织生态学派、理性适应学派和混合学派进行归类,提炼出不同理论流派的主要观点;随后,从组织惯性概念界定、量化、作用效果等方面对不同流派文献进行系统性整理和归纳;最后,在现有研究基础上构建组织惯性概念框架,旨在为后续研究提供便利。     

Environmental terrorism: a critique

As terrorism once again makes news headlines and attracts renewed attention from scholars, the usage of terms related to terrorism may well outpace the development of sound conceptualization of these themes. A case in point is environmental terrorism about which a small body of literature has already been written. The objective of this paper is to examine the theme of environmental terrorism by applying critiques of the more developed but similarly problematic area of environmental security. Three critiques of environmental security literature argue that there is insufficient clarity on how natural resources are linked to conflict, that the term ‘environment’ is not sufficiently clear as a guide to or boundary of a research area, and that the term ‘security’ prioritizes a realist, state-centric perspective that provides a limited perspective on relationships between natural resources and conflict. In this paper, the theme of environmental terrorism is subjected to parallel critiques as a way to examine the usefulness of this concept. Environmental terrorism, as a label, may be only partially helpful as a guide to future research that would also be aided by context-specific examinations of vulnerable natural resource and energy systems.     

What every nurse executive should know about staffing and scheduling technology initiatives

Staffing in hospitals has a history of being based in opinion and tradition, not evidence. In recent years, for many, staffing practices have spun out of control creating chaos in overtime, the use of incentives, entitlement behaviors, dissatisfaction and frustration among nurses, and has opened doors for such things as staffing ratio legislation. Unprecedented pressures around budgets and financial performance have no doubt compounded this situation. We are in a new day, where technology can help us more than ever in a move towards staffing excellence and staffing practices based on evidence. Highly successful implementations of new technologies are the result of good leadership. The effectiveness of staffing and scheduling has significant business, safety, and quality implications that sit at the heart of the nurse executive's role.     

Determining aggregated expectations of future outcomes

This article describes a package of new research techniques that have been developed to allow investigation of long-term global trends. It is based on the theory that expectations (of managers) intimately effect the macro-outcomes of aggregated individual actions. A knowledge of these expectations may be used as a guide to their future actions, and hence to future outcomes overall. To allow this knowledge to be obtained, the qualitative techniques—a combination of focus groups with scenario forecasting—were developed as part of a program of research lasting more than half a decade, and tested against 17 groups consisting of managers from 140 organizations. Subsequent quantitative work, using semantic differentials to map the importance of the 162 dimensions discovered at the qualitative stage, has initially been tested by a survey with respondents from more than 150 organizations.     

BRETTON WOODS II STILL DEFINES THE INTERNATIONAL MONETARY SYSTEM

Abstract.  In this paper we argue that net capital inflows to the USA did not cause the financial crisis that now engulfs the world economy. A crisis caused by such flows has been widely predicted but that crisis has not occurred. Indeed, the international monetary system still operates in the way described by the Bretton Woods II framework and is likely to continue to do so. Failure to properly identify the causes of the current crisis risks a rise in protectionism that could intensify and prolong the decline in economic activity around the world.     

The bumpy road of biomass gasification in the Netherlands: Explaining the rise and fall of an emerging innovation system

In this paper, the concept of System Functions of Innovation Systems is applied to provide an explanation of the success or failure of an emerging technology, i.e. biomass gasification, with empirical data on the evolution of this technology in the Netherlands during 1980-2004. A new list of System Functions has been developed lately and is used to identify the most relevant events in the evolution of the Biomass Gasification Innovation System. We show that a structural misalignment occurred between the institutional framework within which the technology could have been developed and the technical requirements of the technology. Finally, the absence of System Functions such as the guidance of the search, resource allocation and advocacy coalition explains the failure of this technology over time.     

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.     

Why are shortages of hospital RNs concentrated in specialty care units?

This article is the first in a series examining the interplay between the aging of the nurse workforce and other factors driving the growing nursing shortage that are already affecting some specialty areas. Nearly 60% of the current RN workforce is over 40 years of age; and the percentage of RNs under age 30 has fallen by nearly 40% since 1980. The total number of FTE RNs is projected to shrink after 2010, likely resulting in shortages of RNs "when the large baby-boom generation of RNs starts to retire." Because ICUs have historically attracted younger RNs, the rapid decline in the number of RNs in the workforce under age 30 plays a large role in explaining the development of shortages in the ICU. The growing difficulties staffing operating rooms and other peri-operative services is seen as related to the aging work force as more diploma prepared nurses have been attracted to this specialty because they had educational exposure to this area.