Patient safety fears follow staffing guideline decision.

A DECISION to halt development of a guideline for safe nurse staffing in urgent and emergency care settings could have major implications for services this winter, experts have warned.

Leveraging private and public exchanges in an employee benefits strategy.

Health reform is helping to transform the health insurance marketplace and facilitate new opportunities to reevaluate and restructure the underlying framework of employer-sponsored benefits. Central to these opportunities is the emergence of public health exchanges at the state and federal levels offering a coordinated platform of diverse designs and health plans available on a guaranteed issue basis and often with government-provided subsidies. Parallel and complementary to this trend is the emergence of private health exchanges that similarly offer a diversity of plans on a variety of bases. This article shows why, together, these offerings provide potential streamlined solutions for employers as they reevaluate how they facilitate and support access to affordable coverage for their employees (and retirees).

Health care reform the hourly challenge.

For those industries most likely to be transformed by the Patient Protection and Affordable Care Act (ACA), enacting the right strategy is the only strategy. A critical issue will be balancing cost and compliance factors with productivity concerns brought on by changes in the full- and part-time or hourly status of a given workforce. This article discusses industry perspectives in light of the ACA's 2014 implementation date, options for changing staffing models, and how the success of such changes depends on segmenting business units and locations while developing strategies for the different groups. Thus, the mix of full- and part-time employees becomes a more complicated strategy, but an achievable one.

The employer's decision to provide health insurance under the health reform law.

This article considers the employer's decision to continue or to drop health insurance coverage for its workers under the provisions of the 2010 health reform law, on the presumption that the primary influence on that decision is what will produce a higher worker standard of living during working years and retirement. The authors incorporate the most recent empirical estimates of health care costs into their long-horizon, optimal savings consumption model for workers. Their results show that the employer sponsorship of health plans is valuable for maintaining a consistent and higher living standard over the life cycle for middle- and upper-income households considered here, whereas exchange-purchased and subsidized coverage is more beneficial for lower income households (roughly 4-6% of illustrative single workers and 15-22% of working families).

Shared governance and the delivery of labor resources in a 24/7/365 world.

This article explores how shared governance and unit-based scheduling/staffing/ resource management (SSRM) committees can impact the delivery of labor resources 24/7/365 through knowledgeable workforce budgeting and employee scheduling and daily staffing best practices. Two case study examples are included.

Physician M&As: what you need to know before taking the plunge.

In the current healthcare environment, many physicians are considering merging practices. Increasing costs, decreasing revenues, and changing regulations are obstacles today's physicians face, which has led many to "take the plunge" and merge practices. For a successful merger to occur, many factors must be considered. Advantages and disadvantages exist that must be weighed in order to determine if a merger is the best decision. This article considers the factors associated with merging physician practices to determine the best possible outcome for a physician's practice.

Managerial Decision-Making of Nurses in Hospitals: creation and validation of a simulation scenario / Tomada de Decisão Gerencial do Enfermeiro da Área Hospitalar: construção e validação de cenário de simulação / Toma de Decisiones Gerenciales del Enfermero en el Área Hospitalaria: construcción y validación de un escenario de simulación

Abstract Objective: to build and validate a clinical simulation scenario on hospital nurse managerial decision-making competence for undergraduate nursing students. Method: a descriptive and methodological study was carried out in a higher education institution, with the participation of 10 judges and five players. To do so, the conceptual simulation model proposed by Jeffries and standards of the International Nursing Association for Clinical Simulation and Learning were used to prepare the scenario and the checklist. Results: the scenario was called "Managerial decision-making of nurses in the face of adverse events in a hospital". The scenario script and checklist were built for validation. The checklist was face- and content-validated. Afterward, judges used the checklist to validate the scenario, which, in its final version, was composed of Prebriefing (seven items), Scenario in Action (18 items) and Debriefing (seven items). Conclusion: the scenario proved to be a teaching strategy that anticipates the reality of future nurses, bringing them the self-confidence to perform their activities and helping them to act critically and reflectively during decision-making processes.

Resumo Objetivo: construir e validar um cenário de simulação clínica sobre a competência tomada de decisão gerencial do enfermeiro hospitalar para estudantes de graduação em enfermagem. Método: estudo descritivo e metodológico realizado em uma instituição de ensino superior, com a participação de 10 juízes e cinco atores. Utilizou-se o modelo conceitual de simulação proposto por Jeffries e guias padronizadas da International Nursing Association for Clinical Simulation in Learning para a elaboração do cenário e do checklist. Resultados: o cenário ficou denominado como "Tomada de decisão gerencial do enfermeiro diante de eventos adversos no contexto hospitalar". Construiu-se o script do cenário e o checklist para a sua validação. Realizou-se validação de face e conteúdo do checklist. Posteriormente, juízes de posse do checklist, validaram o cenário que, em sua versão final, ficou composto por Prebriefing (sete itens), Cenário em Ação (18 itens) e Debriefing (sete itens). Conclusão: o cenário mostrou-se uma estratégia de ensino capaz de antecipar a realidade do futuro enfermeiro, trazendo autoconfiança na execução de suas atividades, contribuindo para agir de forma crítica e reflexiva durante o processo de tomada de decisão.

Resumen Objetivo: construir y validar un escenario de simulación clínica sobre la competencia en la toma de decisiones gerenciales del enfermero hospitalario para estudiantes del grado en enfermería. Método: estudio descriptivo y metodológico realizado en una institución de educación superior, con la participación de 10 jueces y cinco actores. Se utilizó el modelo conceptual de simulación propuesto por Jeffries y guías estandarizadas de la International Nursing Association for Clinical Simulation in Learning para la elaboración del escenario y del checklist. Resultados: el escenario se denominó "Toma de decisiones gerenciales del enfermero ante eventos adversos en el contexto hospitalario". Se construyó el script del escenario y el checklist para su validación. Se realizó la validez aparente y el contenido del checklist. Posteriormente, los jueces en posesión del checklist, validaron el escenario que, en su versión final, quedó compuesto por Prebriefing (siete ítems), Escenario en Acción (18 ítems) y Debriefing (siete ítems). Conclusión: el escenario demostró ser una estrategia de enseñanza capaz de anticipar la realidad del futuro enfermero, trayendo autoconfianza en la ejecución de sus actividades, contribuyendo para actuar de forma crítica y reflexiva durante el proceso de toma de decisiones.

Voice of the Clinician: the case of an Australian health system.

Purpose The Voice of the Clinician project commenced during an era when practitioner burnout, dissatisfaction, and turnover became an increasingly global health workforce concern. One key problem is clinical staff not being empowered to voice their concerns to decision-makers, as was found in this case study of an Australian public health organization. The following research question informed the present study: What is a better committee system for clinician engagement in decision-making processes? The paper aims to discuss this issue. Design/methodology/approach The Mid North Coast Local Health District in New South Wales aspired to improve engagement between frontline clinicians and decision-makers. Social network analysis methods and mathematical modeling were used in the discovery of how committees are connected to each other and subsequently to other committee members. Findings This effort uncovered a hidden organizational architecture of 323 committees of 926 members which overall cost 84,729 person hours and AUD$2.923 million per annum. Furthermore, frontline clinicians were located far from centers of influence, just 37 percent of committees had terms of reference, and clinicians reported that meeting agendas were not being met. Practical implications In response to the findings, a technological platform was created so that the board of directors could visually see all the committees and the connections between them, thus creating ways to further improve communication, transparency of process, and - ultimately - clinician engagement. Originality/value The breakthrough idea is that all organizational meetings can be seen as a system of engagement and should be analyzed to determine and describe the points and pathways where clinician voice is blocked.

Manufacturing firms' decisions regarding retiree health insurance.

The trend for employers to discontinue offering retiree health insurance has profound implications for a large and growing share of the U.S. older population. The authors explore factors related to the firm's decision to offer and contribute to retiree health insurance using data from manufacturing firms. Their findings indicate that while firm characteristics, such as size and age, affect the probability that a firm offers retiree health insurance, employer contributions to this benefit are significantly related to the firm's financial performance and the alternative insurance options available in the market. The article concludes with a brief discussion of policy-related measures with potentially important implications for the future of retiree health benefits.

Aplicação de uma planilha de controle de estoque em uma unidade de alimentação e nutrição / Application of a stock control sheet in a food and nutrition unit

Introdução: O profissional nutricionista tem, entre suas atribuições, o planejamento de cardápios e o controle de estoque. Dentre as inúmeras atividades inerentes ao setor de alimentação coletiva, a importância da gestão de suprimentos pode passar despercebida e acarretar problemas na execução dos cardápios, gerando monotonia nos mesmos. Assim, ferramentas de controle são necessárias, visto que a monotonia alimentar pode acarretar problemas à saúde dos usuários. Objetivo: Este trabalho teve como objetivo apresentar a elaboração e implantação de uma planilha de controle de estoque em uma unidade de alimentação e nutrição (UAN) de uma instituição de ensino superior pública. Métodos: O trabalho foi desenvolvido e executado no Restaurante Universitário da Escola Agrícola de Jundiaí, da Universidade Federal do Rio Grande do Norte, localizada no distrito de Jundiaí, Macaíba, Rio Grande do Norte, Brasil, com levantamento das fichas de controle. Resultados: O produto deste trabalho foi uma planilha no formato Excel® para controle dos gêneros alimentícios secos do estoque. Observou-se que, além de controlar a entrada e a saída dos gêneros, a planilha auxiliou na tomada de decisão de compra e reabastecimento de suprimentos. Conclusão: Diante dos objetivos almejados, a planilha foi desenvolvida e aplicada com êxito, alcançando a finalidade esperada pelo serviço. (AU)

Introduction: the professional nutritionist has the tasks of planning menus and, consequently, stock control. Among countless activities inherent to the collective food sector, the importance of supply management can go unnoticed and cause problems in the execution of the menus, generating monotony in them. So, control tools are needed, since food monotony can cause health problems for users. Objective: this study aimed to present the preparation and implementation of a stock control spreadsheet in a food and nutrition unit (FNU) of a public higher education institution. Methods: the study was developed and carried out at the Restaurante Universitário da Escola Agrícola de Jundiaí (University Restaurant of the Agricultural School of Jundiaí), of the Universidade Federal do Rio Grande do Norte (Federal University of Rio Grande do Norte), located in the District of Jundiaí, Macaíba, Rio Grande do Norte, Brazil, with a survey of control cards. Results: the product of this study was a spreadsheet in Excel® format to control dry foodstuffs from the stock. It was observed that in addition to controlling the entry and exit of the genders, the spreadsheet also helped in the decision to purchase and replenish supplies. Conclusion: in view of the desired objectives, the spreadsheet was developed and applied successfully, reaching the purpose expected by the service. (AU)