California regional registered nurse workforce forecast

OBJECTIVE: To forecast the shortage of registered nurses (RNs) of the 24 Primary Metropolitan Statistical Areas (PMSA) and Metropolitan Statistical Areas (MSA) in California. BACKGROUND: A nursing shortage prevails nationally and is most serious in the state of California. Successful interventions in the alleviation of the RN shortage will require effective resource allocation and academic program development in various regions throughout the state. While various published studies have focused on nursing workforce development at the state and even regional levels, there are no studies focused on identifying RN shortages at the PMSA or MSA (P/MSA) level. In this report, a forecasting model is developed to systematically analyze the future supply and demand of the RN workforce within each California P/MSA. METHODS: Using accessible public databases, forecasting models were constructed to project the demand and supply of RN jobs in California P/MSAs. In the demand model, population age and size were used as determinants of regionally required RN jobs. In the RN jobs (supply) model, a region's supply of RNs was the net sum of factors increasing and decreasing the regional presence of RN jobs, including RN graduations, migration, and aging of the RN workforce. The combination of these supply and demand models was used to produce regional RN shortage forecasts for future years. RESULTS: Almost all regions exhibited growing shortages by 2020 at rates ranging from 3% to 600%. Using a modified version of the grading rubric of the California Regional Registered Nurse Workforce Report Card (Lin, Lee, Juraschek, & Jones, 2006), only two regions will receive a grade above "C" in 2020. The number of "F" grades will grow to nine. CONCLUSIONS: California has the lowest RN ratio in the United States (Fletcher, Guzley, Barnhill, & Philhour, 2004; Health Resources and Services Administration, 2004a) and this RN workforce forecasting model shows that over the next 15 years, the majority of P/MSAs in California will have increasing RN shortages. This analysis has significant policy implications including the need to create specific plans to mitigate the effect of the California shortage.     

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.     

Occupational commitment, education, and experience as a predictor of intent to leave the nursing profession

This national Internet-based study tested occupational commitment in predicting RN intent to leave the nursing profession. Results showed that occupational commitment was increased by educational level and experience. Findings suggest opportunities for policy changes that may increase retention of registered nurses.     

COMPARING THE NEW ENGLAND AND SOUTHERN CALIFORNIA REGIONAL RECESSIONS

During the early 1990s, both New England and Southern California experienced regional recessions that were much more severe than the national recession of 1990–1991. At first glance, these regional recessions appear to be similar phenomena. However, shift-share analysis conducted at the 3-digit Standard Industry Classification (SIC) level indicates that the underlying causes of the recessions were different. During the late 1980s and early 1990s, New England's manufacturing industries did not perform nearly so well as their national counterparts in creating new jobs and preventing job losses. The loss of regional competitiveness was the main factor explaining that region's recession. On the other hand, most of Southern California's industries performed about as well as their national counterparts during the recession. For Southern California, the industry structure of the region—in particular, its heavy reliance on defense-related production—contributed to the recession more than did a loss of regional competitiveness.     

WILLINGNESS TO PAY FOR DESERT PROTECTION

This paper uses a referendum-style survey approach known as dichotomous-choice contingent valuation to estimate the benefits of restricting the uses of 6.9 million acres of desert land. Statistical techniques estimate the value to California residents of creating three new national parks and 76 new wilderness areas in the high and low deserts of eastern California. The total amount that California residents would be willing to pay to enact desert protection legislation ranges from $177 million to $448 million per year. This estimate hinges on the assumptions that (i) the residents who did not complete and return the survey questionnaire ("nonrespondents") would receive no benefits from desert protection and (ii) the estimate of willingness to pay for the "respondents" is unbiased.     

The economic impact of implementing an ergonomic plan

It is of paramount importance for executives to be well aware of registered nurse (RN) hidden replacement costs related to musculoskeletal injuries. Developing and implementing an ergonomic plan that includes procurement of appropriate lifting equipment at the point of care makes sense. Armed with an ergonomic plan, proactive case management, and a return to work program, the organization is positioned for fiscal success. The ANA's Handle With Care campaign addressed the fact that 12% of RN turnover and 38% of RN workers' compensation pay are related to back strains. Using the benchmarks reported in the Handle With Care campaign, the average cost of replacing an RN who leaves nursing due to a back injury ranged from $25,450 to $38,280 per nurse. Health care worker injury prevention should be valued as a retention strategy, as well as a fiscal responsibility where all stakeholders benefit.     

Personal identity management as a socio-technical network

This paper describes a framework which has proven useful in unpacking the socio-technical nature of personal identity management and in understanding how the introduction of the national identity card in the UK has been ‘configured’ among diverse agencies. The current paper provides an update to developments in the area and evaluates the developing discourse emerging from government circles. The issue is assuming a much larger role within e-government rollout generally and is seen as critical to effective service transformation. This means that the issue is being expanded outside of debate about the introduction of an identity card and is involving a greater range of stakeholders. We use this particular case to help understand a number of thematic and emergent elements surrounding personal identity management which we expect will frame attempts at organisational resolution in this area in the future.     

Registered nurses' perceptions of nursing

In Part II of this six part series on the state of the registered nurse (RN) workforce in the United States, the focus is on RNs' perceptions of nursing including RNs' satisfaction with their jobs in general and on specific elements of their work experiences, such as the quality of professional relationships. Satisfaction with a nursing career and whether RNs would recommend nursing to others are also examined. The improvements in nursing found in this analysis of two national surveys in 2002 and 2004 should be broadly communicated not only to energize individuals and organizations to continue their efforts to improve the workplace environment, but to challenge the many individuals in the nursing profession who hold onto a sense that nothing will ever improve in their organizations.     

A convergent validity test within the payment card format using simulation techniques

A convergent validity test is performed between two groups of versions of the payment card format. The first group, the classic payment card (CPC), asks respondents to report their willingness to pay (WTP) as a point from a list of amounts, and then treats each WTP response as an interval. The second group generates WTP data that may contain both single point and interval values. It includes the two-way-payment ladder (TWPL) (respondents have to tick amounts they would definitely pay and cross amounts they would definitely not pay), and point-interval payment card (PIPC) (respondents have to tick their WTP as either a point or an interval). The test is conducted using data from one TWPL study and two PIPC studies. For each study, we use WTP values stated to simulate 200 CPC WTP datasets, which allows controlling for any behavioral biases likely to confound the outcome of the test. The results challenge the conventional way of eliciting WTP under the CPC and the typical way of treating WTP data from this PC version. Although convergent validity holds between the TWPL/PIPC and CPC, parameter and mean WTP estimates from the TWPL and PIPC are more stable as PC intervals widths increase.     

An index number framework for explaining changes in input productivity– an application to energy efficiency

Lott (2009) finds that nonvoted ballot rates for down-ballot races are greater than those for presidential races, and newer technologies that reduce nonvoted presidential ballots create even greater rates of nonvoting down-ballot than the same older voting technologies. The conclusion is momentous: adopting voting technologies that minimize under-voting in presidential races actually increases under-voting across all races on the same ballot. This study extends Lott's by examining the Congressional vote on the Help America Vote Act of 2002 (HAVA 2002), which established a program to provide funds to states in order to replace punch card voting systems with newer technologies. We focus on the racial component of Lott's finding, specifically that Hispanic-American voters exhibit greater rates of voter fatigue than do white voters. This study posits that, given the large Hispanic-American populations in California and Texas and their propensity to support Democrats in these states, House Democrats from these states would not view the HAVA 2002 as favourably as House Democrats from other parts of the US. Among other results presented here, the data show that support for HAVA 2002 among California and Texas House Democrats was 11.6 percentage points below that of House Democrats from the other 48 states.     

企业知识管理与知识管理能力评价

通过对国外相关文献的分析研究,本文对企业知识及企业知识管理的内涵进行了阐释。在此基础之上,通过与专家学者和企业高层管理人员的广泛交流,提出了知识管理评价理论模型和内容框架,并设立了以度量卡作为企业知识管理能力的评估工具。最后,将此评价体系应用于企业实际测评,发现该评价工具对企业提升技术创新能力和竞争优势提供了较好的知识管理手段。     

我国的央行票据发行与公开市场操作

央行票据是由中国人民银行发行、用以对冲外汇占款的短期债券,是我国实施公开市场操作的主要工具.它是我国外汇大量持续流入、国债市场不发达、央行资产负债结构不合理的产物.央行票据这种替代性操作工具和国债相比,利息成本的承担机制不同.央行票据的利息支付构成了新的货币扩张因素,呈现“反对冲”效应,增大通胀压力,其对冲操作效率也不断降低.与发达国家相比,我国目前还不存在成熟的公开市场操作,未来我国应努力建设多层次发达的国债市场,以提高公开市场操作的效率和货币政策的有效性.     

Outcomes and cost analysis of the impact of unit-level nurse staffing on post-discharg utilization

Under a proposal from the Centers for Medicare and Medicaid Services, hospitals would no longer be reimbursed for 30-day re-admissions or emergency department (ED) visits. Increasing RN staffing to reduce post-discharge utilization is one possible solution, but one that is not financially attractive to hospitals. This study demonstrates the impact of fluctuating staffing levels on ED visits within 30 days of discharge. RN overtime and RN vacancies also affected subsequent ED visits. It is important for nurse managers, directors, and administrators to recognize the impact of RN staffing on patient outcomes. Reimbursement models will need to be realigned to benefit both hospitals and payers.     

试论我国审计报告的改进

审计报告在审计中的地位举足轻重。国家审计报告的形式、内容和质量伴随着经济改革的发展不断变化。当前,我国正经历重要的社会经济转型,经济环境日益严峻与复杂,国家治理体系和治理能力呈现新的特点。这些客观因素要求政府审计报告质量进一步提高且与时俱进。文章针对新的审计环境,从审计报告的内容、形式、质量、责任以及进一步发挥作用等方面研究政府审计报告改进,并提出建设性改进建议,以期更好地满足国家良治的要求。     

Improving retention, confidence, and competence of new graduate nurses: results from a 10-year longitudinal database

Developing competent and confident new graduate nurses who remain with their hospitals is a major challenge. A structured evidence-based RN residency was developed and implemented in hospitals across the United States. Outcomes data were collected from over 6000 new graduate nurses who completed the RN residency over a 10-year period. The results indicate an accelerated increase in competence and self-confidence and a significant decrease in turnover intent and actual turnover. This study provides persuasive evidence that both new graduate nurses and their organizations benefit from the implementation of a structured, clinical immersion RN residency.     

信用卡支付如何影响主观幸福感?——基于萨缪尔森幸福公式的研究

信用卡是一项功能性金融基础设施,现有研究多数止步于信用卡的消费溢价效应,尚未关注其终极福祉效应.文章基于萨缪尔森幸福公式,分析了信用卡支付影响主观幸福感的作用机理,阐述了其并联机制和串联机制.在此基础上,文章运用条件混合过程模型评估了信用卡支付对主观幸福感的影响,采用因果中介效应分析方法识别了其作用机制.研究发现,信用卡支付显著侵蚀了持卡人的主观幸福感,幸福侵蚀效应是通过串联机制而非并联机制传导的.具体来说,信用卡支付经由欲望膨胀渠道和消费实现渠道所构成的串联机制,降低了持卡人的主观幸福感.另外,信用卡支付的幸福侵蚀效应会因使用动机、家中地位以及城乡和地区差异而表现出异质性.     

论海南岛国家公园生态认证管理

随着海南国际旅游岛建设上升为国家战略,海南岛国家公园的筹划建设,近年来海南旅游迅猛发展,为在经济、社会、环境效应方面寻找平衡点,生态旅游认证成为积极有效的手段和工具。目前我国非政府组织还很不发达,特别是在海南省。因此,海南省政府在生态旅游认证体系的初期构建中起主导作用。通过对政府部门、生态旅游供给者和生态旅游者的问卷调查,对海南岛国家公园构建生态旅游认证过程中面临的关键问题进行了分析,并在调查基础上提出了海南岛国家公园进行生态认证管理的对策。     

让公共预算中的政府问责制运转起来——对印度公民预算组织的考察

在贫富差距极度悬殊、种族和教派冲突频繁发生、政府效率低下的环境中,印度的公民预算组织积极投:身社会变革,促进公共参与和政府创新.他们创造出"公民报告卡"、"预算分析"、"预算跟踪"等公民参与预算的方法,以强化内在于公共预算中的政府问责制.他们的思想、观点以及一些具体做法对我国的公共预算制度创新具有一定的借鉴意义.     

Demand-Side Technology Standards Under Inefficient Pricing Regimes

When price-setting regulators haveobjectives other than maximizing socialsurplus, the conservation potential ofdemand-side technology standards can besignificantly diminished. This paperdemonstrates this by empirically recovering thesocially sub-optimal preferences of a group ofwater managers in a groundwater-dependentregion of California and simulating theirinefficient price response to the mandatedadoption of low-flow appliances by homeowners. The resulting reduction in the conservationpotential of these appliances is quantified,and a modest tax is shown to be a relativelycost-effective policy tool for conservation. If non-price conservation policies arepreferred according to equity criteria, thepaper suggests that, in order to preserve theirconservation potential, policy-makers should berequired to continue to set prices as if notechnology standards had been introduced.     

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.