RESUMO
OBJECTIVE: The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. METHODS: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. RESULTS: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. CONCLUSIONS: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, public reporting also had a positive effect on RN staffing. Future research should examine patient outcomes associated with these policies, as well as potential cost savings for hospitals from reduced nurse turnover rates.
Assuntos
Política de Saúde , Mão de Obra em Saúde/legislação & jurisprudência , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Governo Estadual , American Hospital Association , Eficiência Organizacional/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Humanos , Técnicos de Enfermagem/legislação & jurisprudência , Técnicos de Enfermagem/provisão & distribuição , Modelos Lineares , Enfermeiras e Enfermeiros/legislação & jurisprudência , Enfermeiras e Enfermeiros/provisão & distribuição , Assistentes de Enfermagem/legislação & jurisprudência , Assistentes de Enfermagem/provisão & distribuição , Recursos Humanos de Enfermagem Hospitalar/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Estados UnidosAssuntos
Contratos/legislação & jurisprudência , Enfermeiros Internacionais/legislação & jurisprudência , Recursos Humanos de Enfermagem Hospitalar/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/ética , Contratos/economia , Administração Hospitalar/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Filipinas/etnologia , Salários e Benefícios , Estados UnidosAssuntos
Instituição de Longa Permanência para Idosos/organização & administração , Casas de Saúde/organização & administração , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Centers for Medicare and Medicaid Services, U.S. , Infecção Hospitalar/epidemiologia , Abuso de Idosos/legislação & jurisprudência , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas , Instituição de Longa Permanência para Idosos/legislação & jurisprudência , Instituição de Longa Permanência para Idosos/normas , Direitos Humanos , Humanos , Casas de Saúde/legislação & jurisprudência , Casas de Saúde/normas , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/normas , Úlcera por Pressão/epidemiologia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Qualidade da Assistência à Saúde/normas , Delitos Sexuais/legislação & jurisprudência , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVE: Assess the effects of American Council for Graduate Medical Education (ACGME) resident work hour restrictions on the preparedness of incoming facial plastic surgery fellows as assessed by American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship directors. METHODS: Observational survey study evaluating the perception of ACGME resident duty hour change on resident surgical and clinical skills from fellowship directors of AAFPRS fellowship programs in the US. A cross-sectional survey was sent to 47 fellowship directors of AAFPRS fellowship programs. Perceived change in resident clinical and surgical skills were measured using a 5-point Likert scale (1 = significantly improved, 2 = improved, 3 = neither improved nor worsened, 4 = worsened, 5 = significantly worsened) to evaluate 15 benchmarks. RESULTS: Responses received from 36 fellowship directors. The results indicate no statistically significant perceived trend of ACGME duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, cohort analysis demonstrated that fellowship directors with more than 10 years of service perceived a more negative impact in 2 clinical benchmarks (assessment/planning and basic exposure) over time. CONCLUSIONS: The study results appear to show no significant perceived trend over time on the effect of duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, there are some apparent opinion differences between fellowship directors separated by years of service, with more negative perceptions noted in 2 clinical areas by those with more than 10 years of service. This study is in line with the more recent literature that suggests a trend toward a less negative perception of the duty hour change. This may suggest resident education is adapting to the ACGME duty hour regulations.
Assuntos
Competência Clínica , Docentes de Medicina/psicologia , Internato e Residência/normas , Percepção , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Cirurgia Plástica/educação , Estudos Transversais , Bolsas de Estudo , Humanos , Fatores de Tempo , Estados UnidosRESUMO
OBJECTIVES: We examine how statutory workweeks affect workers' provision of long-term care for their non-coresident elderly parents. METHOD: The Korean government reduced its statutory workweek from 44 to 40 hr, gradually from larger to smaller establishments, between 2004 and 2011. Using multiple regressions, we assess how the reduction affected visits, financial transfers, and in-kind transfers to parents. Annual longitudinal data come from the 2005 to 2013 waves of the Korea Labor and Income Panel Study. RESULTS: The reduction caused an increase in the frequency of visits and in-kind transfers among male workers, with no significant impact on their financial transfers. Among female workers, we found no impact on any outcomes. DISCUSSION: We interpret the findings within the context of developed Asian countries with long work hours and Confucian traditions, and suggest regulating workweeks as a policy tool to encourage familial long-term care in the rapidly aging societies.
Assuntos
Cuidadores , Assistência de Longa Duração , Pais , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Adolescente , Adulto , Idoso , Feminino , Apoio Financeiro , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Adulto JovemRESUMO
. The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. AIM: To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. METHODS: The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. RESULTS: The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of 1.828.562,00. CONCLUSIONS: The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.
Assuntos
Hospitais/normas , Relações Enfermeiro-Paciente , Assistentes de Enfermagem/normas , Recursos Humanos de Enfermagem Hospitalar/normas , Admissão e Escalonamento de Pessoal/normas , Médicos/normas , Carga de Trabalho , União Europeia , Órgãos Governamentais , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Itália , Assistentes de Enfermagem/economia , Assistentes de Enfermagem/legislação & jurisprudência , Recursos Humanos de Enfermagem Hospitalar/economia , Recursos Humanos de Enfermagem Hospitalar/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/economia , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Médicos/economia , Médicos/legislação & jurisprudência , Carga de Trabalho/economia , Carga de Trabalho/legislação & jurisprudência , Carga de Trabalho/normasAssuntos
Medicina de Família e Comunidade/organização & administração , Fadiga/prevenção & controle , Segurança do Paciente , Plantão Médico/organização & administração , Canadá , Medicina de Família e Comunidade/educação , Humanos , Internato e Residência , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Gestão de RiscosRESUMO
INTRODUCTION: Transport operators seeking to operate outside prescriptive fatigue management regulations are typically required to present a safety case justifying how they will manage the associated risk. This paper details a method for constructing a successful safety case. METHODS: The method includes four elements: 1) scope (prescriptive rules and operations affected); 2) risk assessment; 3) risk mitigation strategies; and 4) monitoring ongoing risk. A successful safety case illustrates this method. It enables landing pilots in 3-pilot crews to choose the second or third in-flight rest break, rather than the regulatory requirement to take the third break. Scope was defined using a month of scheduled flights that would be covered (N = 4151). These were analyzed in the risk assessment using existing literature on factors affecting fatigue to estimate the maximum time awake at top of descent and sleep opportunities in each break. Additionally, limited data collected before the new regulations showed that pilots flying at landing chose the third break on only 6% of flights. RESULTS: A prospective survey comparing subjective reports (N = 280) of sleep in the second vs. third break and fatigue and sleepiness ratings at top of descent confirmed that the third break is not consistently superior. The safety case also summarized established systems for fatigue monitoring, risk assessment and hazard identification, and multiple fatigue mitigation strategies that are in place. DISCUSSION: Other successful safety cases have used this method. The evidence required depends on the expected level of risk and should evolve as experience with fatigue risk management systems builds.Gander P, Mangie J, Wu L, van den Berg M, Signal L, Phillips A. Preparing safety cases for operating outside prescriptive fatigue risk management regulations. Aerosp Med Hum Perform. 2017; 88(7):688-696.
Assuntos
Medicina Aeroespacial , Fadiga , Pilotos , Medição de Risco , Gestão de Riscos , Segurança , Sono , Vigília , Humanos , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Estudos ProspectivosAssuntos
Enfermagem Geriátrica/normas , Advogados/legislação & jurisprudência , Casas de Saúde/normas , Recursos Humanos de Enfermagem/normas , Humanos , Medicaid/normas , Recursos Humanos de Enfermagem/provisão & distribuição , Pennsylvania , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Estados UnidosAssuntos
Contratos , Corpo Clínico Hospitalar , Negociação , Admissão e Escalonamento de Pessoal , Greve , Consultores , Contratos/economia , Contratos/legislação & jurisprudência , Governo , Mortalidade Hospitalar , Humanos , Corpo Clínico Hospitalar/economia , Corpo Clínico Hospitalar/provisão & distribuição , Moral , Admissão e Escalonamento de Pessoal/economia , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Sociedades Médicas , Medicina Estatal , Fatores de Tempo , Reino UnidoRESUMO
Last month, Scotland's first minister Nicola Sturgeon declared Scotland would enshrine safe nurse staffing levels in law.