The impact of California's staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis.

BACKGROUND: Despite the importance of adequate hospital nurse staffing, California is the only state with minimum nurse-to-patient ratio mandates. The health care workforce is historically "countercyclical"-exhibiting growth during economic recessions when employment in other sectors is shrinking. PURPOSE: This study was to examine how staffing mandates impact hospital nurse staffing during economic recessions. METHOD: We compared hospital nurse staffing in California and in other states over 20 years to examine differences before and after the California mandate and, within the postmandate period, before, during, and after the Great Recession of 2008. FINDINGS: Staffing differences increased during the postmandate period due to faster growth in California staffing compared to other states, except during the Great Recession, when staffing remained stable in California but declined in other states. DISCUSSION: State legislators deliberating staffing mandates should consider the protective factor such policies provide during economic recessions and the implications for the quality and safety of care.

Increasing nursing research capacity: The roles and contributions of nurse scientists within healthcare systems in the Greater Philadelphia region.

PhD prepared nurse scientists within healthcare systems are uniquely positioned to advance nursing science through research and evidence-based practice (EBP) initiatives due to their ability to closely collaborate with nurses and other healthcare professionals in the clinical setting. The purpose of this paper is threefold: 1) to describe the roles and contributions of Nurse Scientists, from their perspectives, in four different health care systems in the Greater Philadelphia area, three of which are Magnet® designated hospitals; 2) to highlight organizational approaches to increase nursing research and EBP capacity; and 3) to explore strategies that Nurse Scientists used to overcome barriers to build nursing research capacity. Nurse Scientists employed in these healthcare systems share many of the same essential roles and contributions focused on developing nursing research and EBP initiatives through education and mentorship of clinical nurses, conduct and oversight of independent research, and dissemination activities. With supportive executive nurse leadership, the Nurse Scientists within each healthcare system employed different strategies to overcome barriers in building nursing research and EBP capacity. Nurse scientists within healthcare settings have potentially powerful positions to generate and apply new knowledge to guide nursing practice and improve outcomes.

Pediatric Extracorporeal Cardiopulmonary Resuscitation Patient With Traumatic Subarachnoid Hemorrhage and Takotsubo Syndrome.

Takotsubo syndrome is rare in pediatric patients but must be considered in patients with subarachnoid hemorrhage with pulmonary edema and cardiomyopathy. A systematic, collaborative approach is needed to facilitate emergent transfer of patients where extracorporeal cardiopulmonary resuscitation (e-CPR) is used as a lifesaving measure. Extracorporeal membrane oxygenation (ECMO) use in transport requires preplanning, role delineation, resources, and research efforts to be successful. We present an unusual transport case of successful e-CPR/ECMO treatment of Takotsubo syndrome in a 12-year-old boy with an isolated traumatic intracranial injury, cardiomyopathy with pulmonary edema, and multiple cardiac arrests.

The Impact of a Statewide Coalition to Decrease Pediatric All-Terrain Vehicle Injuries.

Children lack the cognitive judgment and motor skills to safely operate all-terrain vehicles (ATVs) in all situations. The Trauma Team clinicians at Nemours Children's Health System/Alfred I. duPont Hospital for Children (N/AIDHC) were concerned about the severity of injuries sustained by children when they were either the driver or a passenger on an ATV. Although this subset of children within the trauma registry did not account for a high volume of trauma patients, these children sustained a higher proportion of severe injuries. In 2012, the Trauma Team at N/AIDHC partnered with Nemours Health & Prevention Services to form a broad-based statewide coalition in order to impact this alarming trend and to improve safety for those who ride ATVs. The coalition worked together to reach consensus and to successfully advocate for the passage of legislation requiring helmets and limiting passengers for recreational ATV riders under the age of 18. This legislation was signed into law in July 2015. Working with both ATV dealers and a national industry association, the coalition also has been successful in bringing to the State of Delaware, an ATV safety training course for riders in 2016. An evaluation of the impact of this new legislation using state trauma data will begin in 2017.

Better Nurse Staffing and Nurse Work Environments Associated With Increased Survival of In-Hospital Cardiac Arrest Patients.

BACKGROUND: Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. OBJECTIVES: To determine the association between nurse staffing, nurse work environments, and IHCA survival. RESEARCH DESIGN: Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. SUBJECTS: A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). RESULTS: Each additional patient per nurse on medical-surgical units was associated with a 5% lower likelihood of surviving IHCA to discharge (odds ratio=0.95; 95% confidence interval, 0.91-0.99). Further, patients cared for in hospitals with poor work environments had a 16% lower likelihood of IHCA survival (odds ratio=0.84; 95% confidence interval, 0.71-0.99) than patients cared for in hospitals with better work environments. CONCLUSIONS: Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an IHCA. These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments. Improving nurse working conditions holds promise for improving survival following IHCA.

Nurse experiences and perspectives with missed nursing care during COVID-19: A qualitative study.

AIM: This study aimed to determine clinical nurse and nurse manager perspectives on missed nursing care (MNC) during the COVID-19 pandemic. DESIGN: This study utilized a qualitative exploratory descriptive design. METHODS: Data were obtained through focus groups and virtual interviews. Purposive sampling was used to select nurse and nurse manager participants in COVID-19 units and the Emergency Department in one large healthcare organization in the northeastern United States of America. RESULTS: A total of 15 nurses and nurse managers participated in the study. Results revealed five categories: medication delivery, turning patients, double checks, communication and rapport, and patient surveillance. CONCLUSIONS: A variety of factors contributed to the perceptions and experiences of MNC of COVID-19 patients during the early stage of the pandemic. The COVID-19 crisis put additional and unparalleled pressure on a strained nursing workforce. Hospital leaders are responsible for ensuring their frontline nurses have the resources they need to feel supported in their roles regardless of the presenting circumstances. IMPLICATIONS FOR THE PROFESSION: Nurse leaders should employ evidence-based strategies such as promoting and championing teamwork to support staff and reduce incidences of MNC during crises. Our current work may serve as a basis for informing future revisions of pre-pandemic measurement tools when applied in a pandemic-specific context. REPORTING METHODS: This manuscript adheres to the standards for reporting qualitative research (SRQR); a synthesis of recommendations. PUBLIC CONTRIBUTION: There was not patient or public contribution for this study.

Interprofessional simulation on nurse interruptions.

This project was an initial attempt to help nonnurses who will potentially work in the health care field to gain an understanding of the impact of distractions and interruptions on nurses. Graduate students in the Institute for Health Care Improvement Open School participated in an unfolding simulation in a hospital setting to expose them to the challenges of providing care in a work environment that often includes multiple interruptions.

Hospital nurse staffing: choice of measure matters.

BACKGROUND: Researchers frequently use nurse staffing measures to examine hospital quality of care. Measure choices include nurse-reported perception of staffing adequacy, nurse-reported patient workloads, and empirically derived hours per patient day (HPPD). OBJECTIVE: To examine the correlations across these measures and identify factors associated with these staffing measures. DESIGN, SETTINGS, AND SUBJECTS: A cross-sectional correlational study of 92 medical-surgical, rehabilitation, and intermediate in 11 acute care hospitals was carried out. METHODS: We surveyed registered nurses on their perceived staffing adequacy, last shift patient workload, and unit-level structures and processes of care delivery. Individual responses to these measures were aggregated to the nursing unit level, and unit-level HPPD, unit-level case mix index were obtained from each hospital's administrative data. After examining the correlation matrix across variables, those associated with the 3 staffing measures were then examined using linear regression. RESULTS: HPPD and the nurse-reported patient workload on last shift were correlated (r=-0.276, P=0.008), and perceptions of the adequacy of staffing and nurse-reported patient workload on last shift were correlated (r=-0.384, P=0.000). In multivariable analyses, inadequate numbers of assistive personnel was significantly associated with both perceived staffing adequacy and nurse-reported patient loads. Unit-level case mix index was significantly associated with both HPPD and nurse-reported patient loads. These data suggest that the 3 measures of nurse staffing are not highly correlated, and may capture different elements of the unit context to explain nurse staffing. Researchers should consider the correlates of these measures when selecting nurse staffing measures for future investigations.

Nursing staff teamwork and job satisfaction.

AIM: The aim of the present study was to explore the influence of unit characteristics, staff characteristics and teamwork on job satisfaction with current position and occupation. BACKGROUND: Teamwork has been associated with a higher level of job satisfaction but few studies have focused on the acute care inpatient hospital nursing team. METHODS: This was a cross-sectional study with a sample of 3675 nursing staff from five hospitals and 80 patient care units. Participants completed the Nursing Teamwork Survey (NTS). RESULTS: Participants' levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher (P<0.001) and perceived their staffing as adequate more often (P<0.001). Type of unit influenced both satisfaction variables (P<0.05). Additionally, education, gender and job title influenced satisfaction with occupation (P<0.05) but not with current position. CONCLUSIONS: Results of this present study demonstrate that within nursing teams on acute care patient units, a higher level of teamwork and perceptions of adequate staffing leads to greater job satisfaction with current position and occupation. IMPLICATIONS FOR NURSING MANAGEMENT: Findings suggest that efforts to improve teamwork and ensure adequate staffing in acute care settings would have a major impact on staff satisfaction.