Experiential clinical learning for newly licensed PhD students: Transforming nursing PhD education through academic-practice partnerships.

The growing national and international need for nurse scientists to transform health care has encouraged advances in nursing doctoral programs. The Hillman Scholars in Nursing Innovation, a program integrating BSN and PhD education, inspired the creation of the Hillman Clinical Fellowship ("Fellowship"). The Fellowship helps students transitioning from the BSN to PhD gain clinical experiences as newly graduated registered nurses, thus mitigating a common concern that students are naïve about the clinical setting. In collaboration with a practice partner, the Fellowship fosters development of clinical skills consistent with Patricia Benner's Novice to Expert Model. Fellows build clinical skills concurrent with the development of research proficiencies in the PhD program. This Fellowship can be adapted by other schools seeking to introduce curricular innovations that address the needs of early career PhD students, enhance academic-practice partnerships, and meet the growing need for more clinically focused PhD prepared nurses.

The Effect of the Magnet Recognition Signal on Hospital Financial Performance.

EXECUTIVE SUMMARY: The objective of this study was to investigate the effect of the Magnet Recognition (MR) signal on hospital financial performance. MR is a quality designation granted by the American Nurses Credentialing Center (ANCC). Growing evidence shows that MR hospitals are associated with various interrelated positive outcomes that have been theorized to affect hospital financial performance.In this study, which covered the period from 2000 to 2010, we applied a pre-post research design using a longitudinal, unbalanced panel of MR hospitals and hospitals that had never received MR designation located in urban areas in the United States. We obtained data for this analysis from Medicare's Hospital Cost Report Information System, the American Hospital Association Annual Survey Database, the Health Resources & Services Administration's Area Resource File, and the ANCC website. Propensity score matching was used to construct the final study sample. We then applied a difference-in-difference model with hospital fixed effects to the matched hospital sample to test the effect of the MR signal, while controlling for both hospital and market characteristics.According to signaling theory, signals aim to reduce the imbalance of information between two parties, such as patients and providers. The MR signal was found to have a significant positive effect on hospital financial performance. These findings support claims in the literature that the nonfinancial benefits resulting from MR lead to improved financial performance. In the current healthcare environment in which reimbursement is increasingly tied to delivery of quality care, healthcare executives may be encouraged to pursue MR to help hospitals maintain their financial viability while improving quality of care.

Alternative Payment Models and Team-Based Care.

Team-based care delivery models offer opportunities to improve quality of care and outcomes for patients, providers, and communities. Because of various barriers, including disincentives in the payment system, team-based care has not reached its potential. This commentary discusses team-based care in the context of emerging value-based payment models and the potential costs of, and opportunities afforded by, these models.

Internationally educated nurses in the United States: Their origins and roles.

Despite the importance of the internationally educated nurse (IEN) workforce, there has been little research on the employment settings of IENs and other aspects of their employment. We analyzed data from the 2008 National Sample Survey of Registered Nurses to characterize IENs in the United States using descriptive statistics and multivariate ordinary least squares regression. We find notable differences in the decade of immigration, current age, and highest nursing education across the countries in which IENs were educated. IENs are more likely to be employed in nursing and to work full-time. They receive higher total annual earnings and earn higher average hourly wages. However, when demographic, human capital, and employment characteristics are held constant, IENs from every country except Canada earn no more than U.S.-educated nurses. Future research should seek to identify the causes of these employment and earnings differences to understand the role and impact of the IEN workforce.

A literature review of nursing turnover costs.

AIM: To report the findings of a literature review of studies examining nursing staff turnover costs published between 1990 and 2010. BACKGROUND: Nurse turnover is a global concern that is both costly for health-care organizations and, in the context of the work environment, affects quality and safety. EVALUATION: We reviewed past literature and describe the conceptualization of nurse turnover, evaluate the methodologies and calculation of costs, identify the reported range of turnover costs and provide suggestions for future study. KEY ISSUES: We report inconsistencies in past studies in terms of the conceptualization and measurement of nurse turnover and turnover rates, the methodologies for gathering data and the data sources used, the approaches for calculating turnover costs and the resulting nursing staff turnover costs estimated. CONCLUSION: Past studies reached different conclusions about nurse turnover. We still need to explore the actual costs and benefits of nurse turnover and retention. IMPLICATIONS FOR NURSING MANAGEMENT: This study should be helpful for nurse executives as they build a business case to address nurse turnover in their organizations, and for policy-makers as they develop policies about turnover.

North Carolina's nursing workforce: planning today for a reformed tomorrow.

Nurses are the single largest component of North Carolina's health workforce, and nursing jobs are an essential driver of the state's economic recovery. We propose 5 recommendations for creating a nursing workforce system that, if implemented, would position the state to meet the future health care needs of North Carolinians.

The longitudinal study of turnover and the cost of turnover in emergency medical services.

BACKGROUND: Few studies have examined employee turnover and associated costs in emergency medical services (EMS). OBJECTIVE: To quantify the mean annual rate of turnover, total median cost of turnover, and median cost per termination in a diverse sample of EMS agencies. METHODS: A convenience sample of 40 EMS agencies was followed over a six-month period. Internet, telephone, and on-site data-collection methods were used to document terminations, new hires, open positions, and costs associated with turnover. The cost associated with turnover was calculated based on a modified version of the Nursing Turnover Cost Calculation Methodology (NTCCM). The NTCCM identified direct and indirect costs through a series of questions that agency administrators answered monthly during the study period. A previously tested measure of turnover to calculate the mean annual rate of turnover was used. All calculations were weighted by the size of the EMS agency roster. The mean annual rate of turnover, total median cost of turnover, and median cost per termination were determined for three categories of agency staff mix: all-paid staff, mix of paid and volunteer (mixed) staff, and all-volunteer staff. RESULTS: The overall weighted mean annual rate of turnover was 10.7%. This rate varied slightly across agency staffing mix (all-paid = 10.2%, mixed = 12.3%, all-volunteer = 12.4%). Among agencies that experienced turnover (n = 25), the weighted median cost of turnover was $71,613.75, which varied across agency staffing mix (all-paid = $86,452.05, mixed = $9,766.65, and all-volunteer = $0). The weighted median cost per termination was $6,871.51 and varied across agency staffing mix (all-paid = $7,161.38, mixed = $1,409.64, and all-volunteer = $0). CONCLUSIONS: Annual rates of turnover and costs associated with turnover vary widely across types of EMS agencies. The study's mean annual rate of turnover was lower than expected based on information appearing in the news media and EMS trade magazines. Findings provide estimates of two key workforce measures--turnover rates and costs--where previously none have existed. Local EMS directors and policymakers at all levels of government may find the results and study methodology useful toward designing and evaluating programs targeting the EMS workforce.

Nurse working conditions and nursing unit costs.

The authors examined the relationship between nurse working conditions and nursing unit costs in 210 general medical, general surgical, and general medical surgical units in 112 randomly selected U.S. hospitals. Data were collected from registered nurses (N = 3,747 and 2,878), patients (N = 2,100), study coordinators, and secondary data sources. After controlling for relevant hospital, nursing unit, and patient characteristics, the authors found that good working conditions did not increase nursing unit costs. Teaching status was associated with higher costs, whereas larger unit size was associated with lower costs. Higher proportions of registered nurses and licensed practical nurse staffing were also associated with higher costs. Patient variables were not significantly related to costs. We suggest a variety of strategies that managers may use to improve working conditions.

Chief nursing officer turnover: chief nursing officers and healthcare recruiters tell their stories.

Chief nursing officers (CNOs) develop environments in which quality patient care is delivered and nurses enjoy professional practice. Because of the growing turbulence in this vital role, the American Organization of Nurse Executives conducted a study to examine CNO turnover as described in interviews with CNOs and healthcare recruiters to inform the development of strategies to improve CNO recruitment and retention and ease transition for those who turn over. The authors present the findings from this research and describe American Organization of Nurse Executives' initiatives to address the identified needs.

Buried alive: the presence of nursing on hospital Web sites.

BACKGROUND: Increasingly, hospitals are using sites on the World Wide Web (Web) to market their services and products and to advertise employment opportunities. These Web sites are a potential resource for information on the hospitals' nursing care and nurses' impact on patient outcomes. OBJECTIVE: The aim of this study was to explore the presence of nursing-accessible and visible data on nurses, nursing practice, or nursing care-on hospital Web sites. METHODS: A random sample of 50 hospital Web sites from the U.S. News and World Report's 2003 list of America's best hospitals was examined. A tool developed to capture the characteristics that denote a presence of nursing was used to examine hospital Web sites. RESULTS: All 50 sites had at least two occurrences of visible data in the form of pictures, graphics, or text that related to nurses, nursing care, or nursing practice. However, nurse-related content on these hospital Web sites was minimally to somewhat present and was frequently located on pages deep within the site. DISCUSSION: The presence of nursing on hospital Web sites could represent the importance of nursing, nursing practice, or nursing care for patients entering hospital systems. Instead, nursing content on hospital Web sites primarily focuses on nursing employment.