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.     

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.     

Changing the start of the hospital workweek

Essential to the success of a project of this magnitude were: (a) having the support and input of both management and staff; (b) clarifying federal wage and hour issues; (c) allowing adequate time for the change process; (d) determining impact of change on every hospital department; (e) providing hospital departments with necessary information, resources, and support to accommodate the change; and (f) communicating the change to each hospital employee in a timely manner. Can a hospital provide budget-neutral, flexible nurse schedules necessary to recruit and retain registered nurses? Yes, they can if they know how to do it. By redefining the workweek, Saint Marys realized an annual decrease of almost $750,000 in scheduled overtime expense for full-time nurses working 12-hour weekends, every third weekend. If health care institutions want the competitive edge in recruiting nurses, they will need to provide work schedules that are not only attractive, but also help ensure a positive "bottom line."     

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.     

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 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.     

Politics, economics, and nursing shortages: a critical look at United States government policies

The economic concept that the independent actions of buyers and sellers tend to move the market toward equilibrium where there is no shortage or surplus is basic in the classic and current literature of economics. The problem with subsidies is that nurses who receive subsidized educations are able to provide nursing services for less compensation because they paid less or nothing for their educations. Subsidies may be politically appealing, but they override market forces of supply and demand. The demand for nurses and nursing instructors can be met and maintained for generations to come with policies that expand roles and reimbursement for APNs and encourage the nurse and nursing instructor labor markets to correct themselves by providing fair compensation under Magnet status working conditions. Politics and policies meant to correct the nursing shortage should focus less on how to reduce the cost of producing nurses, and more on how to afford to compensate nurses with wages and benefits that achieve market equilibrium.     

Registered nurses' perspectives on health care and the 2008 presidential election

As this historic presidential election draws near, what do RNs think of our nation's priorities? Which candidates do they think will be most effective in shaping our health care system and addressing the most pressing issues of our time? The results of this survey show that RNs do not identify overwhelmingly with one political ideology or party and, in fact, they closely resemble the public on these political dimensions. The data also show that RNs identify health care issues as the most important problem facing the nation. RNs who believe that it is the responsibility of the government to provide health insurance to those without it, have more confidence in the government to achieve this outcome, and are more likely to be Democrats than Republicans. The presidential election is expected to be highly contested and could be determined by a relatively small margin of votes and, thus, nurses should recognize their chances of influencing the outcome of the election. The data from this survey provide baseline information potentially useful to increasing the political influence of the nursing profession, informing other organizations about where they might align with nurses, and helping candidates and the political parties compete more effectively in seeking the support of roughly 3 million RN voters.     

Foreign-educated nurses: an overview of migration and credentialing issues

It is important for nursing administrators to understand the migration and credentialing process as they integrate foreign-educated nurses into United States health care systems. Issues and considerations related to migration and credentialing of foreign-educated nurses are summarized.     

Public perceptions of nursing careers: the influence of the media and nursing shortages

The high public regard for nurses has not necessarily translated into an adequate supply of individuals who are willing to be nurses. The expected future demand for nurse labor challenges us to look more closely at the public's perceptions of nursing and nursing careers, and consider how they are shaped by personal experience, media messages, and socio-demographic factors. As part of ongoing efforts to examine factors shaping the future of the nursing workforce, a national survey of Americans was conducted to probe attitudes toward the nursing profession and their experiences with nurses. The data in this national survey of the public about nursing demonstrate that the nursing profession is highly respected and that the vast majority of the general public would recommend nursing careers to qualified students. If the profession is so well thought of and so highly recommended, why are there persistent concerns that not enough people are becoming RNs to avoid or at least slow down the development of future shortages? A prolonged and persistent effort is needed to educate people about nursing careers, to stimulate the expanded production of nursing faculty, and to bring creative approaches to financing nursing education and workforce improvements to convert the large number of seriously interested candidates into the nursing profession.     

Estimating the time involved in managing the 'unoccupied bed:' a time and motion study

Occupied bed days are often used as a demand indicator when calculating the number of nurses required to provide safe care. However, such calculations fail to take into account the amount of nursing time consumed by the "unoccupied bed." This study used direct observation time-and-motion methods to estimate the time and costs associated with a bed that is unoccupied. The average time taken to complete all of the activities associated with a bed that was unoccupied due to an internal transfer was 8.65 minutes, for a patient discharge 26.27 minutes, and for a patient admission 37.7 minutes. An average daily cost for activities surrounding these patient movements was approximately $386/day (AUD) in registered/enrolled nursing salaries alone. The unoccupied bed is not resource neutral and time associated with its maintenance should be considered when calculating nursing requirements to provide safe care.     

Staff nurse financial management committees--the nurse manager's guide to effective financial performance

As Cohen states (1991, p. 25), "The future role that nursing will play in the health care delivery system is one of many major issues faced by contemporary nursing...Nursing must be able to determine realistically the cost of and evaluate the effectiveness of nursing care provided to its patients." A unit-based financial management committee is one very effective way of teaching the skills needed for the professional nurse to advance the practice in financial management. This will help nursing gain the professional status that they have always worked for. But beyond these very lofty ideals, a staff nurse managed financial management committee can make the nurse manager's life much easier. Staff nurses need to understand and accept the importance of managing the financial as well as the quality side of patient care. When this happens, the budget becomes theirs. Nurses develop a sense of ownership of the budget and learn how to effectively manage the unit's finances. Much staff nurse brain power is not used. Systems must be developed to access nurses' effective ideas for financial management--first in a financial management committee and then on the unit. Not only will this develop the professional status that nurses need and deserve, but it will also impact the cost of health care. In a society where the cost of an appendectomy requires Dayton Hudson to sell 39,000 Ninja Turtle action figures, Atlantic Richfield to sell 192,000 gallons of gas a day, Anheuser-Busch to sell 11,627 6-packs of 12 oz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Navajo nation public health nurses inspire thoughts on health care reform

The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.     

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.     

The more things change

The nursing profession's ability to influence public policy rests on individual as well as collective actions. Given Web-based information resources available today, nurses, regardless of where they reside, can be informed and engaged in health policy.     

The nursing shortage: can information technology help?

There is no doubt that the nursing shortage is a real and valid concern for the medical community. American Hospital Association President Dick Davidson reports: "America needs up to 126,000 nurses now, as well as more pharmacists, lab technicians, support staff and others. We need immediate action to help alleviate this situation" (American Hospital Association, 2001). Clinical information systems can be one of those immediate actions that can help nurses feel more confident about the care they are delivering. In addition to preventing medical errors, streamlining workflow and communications, and reducing redundant data entry, these systems can have a lasting and positive effect on overall job satisfaction, providing a significant influence on retaining our invaluable nursing resources.     

Nurses leading the response to the crisis of palliative care for vulnerable populations

All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.     

The 'Parent Shift' program: incentives for nurses, rewards for nursing teams

To create new opportunities for nurses to reenter the workforce, a RN p.r.n. program must meet the needs of nurses who wish to make dual commitments to home and work. The Parent Shift program provides an innovative model of attracting and retaining nurses in a hospital workforce. Many nurses who joined the program were away from the field of nursing for many years and were drawn to the program because of the promise of flexible shifts and minimal requirements for participation. In this study, flexible shifts not only encouraged program entry, they were also a powerful motivator for continued program participation over time. Parent Shift nurse presence was perceived by nurse managers to decrease stressors and improve time efficiency of full-shift staff.