Utilizing a scope and span of control tool to measure workload and determine supporting resources for nurse managers.

The scope and span of control of the nurse manager directly impact turnover, succession planning, and satisfaction. Measuring and benchmarking scope and span of control remain a challenge. An interprofessional team across an integrated health delivery system developed and implemented such a tool, which was used to determine the amount of operational and clerical support for managers. Since implementation, there has been a decrease in turnover and time to fill nurse manager positions.

What do nurses and midwives value about their jobs? Results from a discrete choice experiment.

OBJECTIVES: To examine nurses' and midwives' preferences for the characteristics of their jobs. METHODS: A discrete choice experiment of 990 nurses and midwives administered as part of a survey of nurses and midwives in Victoria, Australia. RESULTS: Autonomy, working hours, and processes to deal with violence and bullying were valued most highly. Nurses and midwives would be willing to forgo 19% and 16% of their annual income for adequate autonomy and adequate processes to deal with violence and bullying, compared to poor autonomy and poor processes for violence and bullying. They would need to be paid an additional 24% to increase their working hours by 10% ($73 per hour). Job characteristics that were less important were shift work, nurse to patient ratios, and public or private sector work. CONCLUSIONS: Policies to improve retention and job satisfaction of nurses and midwives should initially focus on autonomy, processes to deal with violence and bullying, and reasonable working hours. Further research on the cost-effectiveness of these different policies is needed.

Creating a culture for value measurement.

OSF HealthCare's executive dashboard provides: A detailed view of top-level measures to frame OSF's mission and vision for all stakeholders. An easily understood, holistic snapshot of performance An assessment of relationships among system goals, initiatives, and results. Explicit understanding of the organization's priority performance measures and the extent to which they need to improve. A vehicle for transitioning to a value-based business model.

Needs of labor and delivery nurses caring for women undergoing pregnancy termination.

OBJECTIVE: To explore the psychosocial, educational, and administrative support needs of labor and delivery (L&D) nurses who care for women undergoing pregnancy termination. DESIGN: A qualitative, descriptive design. SETTING: This study was conducted on a L&D unit at a large, university-affiliated hospital in Quebec, Canada. PARTICIPANTS: A convenience sample of 10 L&D nurses participated in this study. Ages of participants ranged from 25 to 55 years, and experience on the unit ranged from 1 to 30 years. METHODS: One-time, face-to-face interviews were conducted with each participant. Audio-recorded interviews were transcribed verbatim and analyzed using inductive content analysis. RESULTS: Participants valued interpersonal support from nurse colleagues and guidance from experienced nurses in managing the emotional aspect of this care. They raised concerns about the effect of nursing workload and patient-to-nurse ratios on patient care. Nurses noted a desire for knowledge and skill-building through access to evidence-based literature, continuing education sessions, and workshops. They also expressed a need for more information regarding the genetic counseling process and community resources available to women undergoing pregnancy termination. CONCLUSION: Ensuring continuity of care through knowledge sharing related to genetic counseling and community resources creates the context for holistic patient care. Increased attention to the particular needs of L&D nurses providing care to women undergoing termination may enhance the quality and safety of care for this unique population.

From words to action: visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital.

PURPOSE: The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. DESIGN/METHODOLOGY/APPROACH: A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. FINDINGS: Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. RESEARCH LIMITATIONS/IMPLICATIONS: The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. PRACTICAL IMPLICATIONS: The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. SOCIAL IMPLICATIONS: Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. ORIGINALITY/VALUE: The authors draw on solid theoretical frameworks--the complexity theory, team effectiveness model and the social identity theory--to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level.

Redesign standardizes care coordination.

By centralizing administrative and clerical tasks usually performed by clinical staff, the care coordination department at Sentara Healthcare, with headquarters in Norfolk, VA, has freed the bedside staff to concentrate on case management and discharge planning. RN care coordinators and master's prepared social workers collaborate to manage care on the unit, holding a daily huddle and participating in multidisciplinary rounds. Clerical staff set post-discharge appointments with primary care providers while the patient is still in the hospital. Staff members at a centralized Resource Management Center, created at a new location, are responsible for utilization management, including admissions reviews, continuing stay reviews, and retrospective reviews and facilitation of discharges for patients in all hospitals.

Use of a simulated administrative decision-making exercise in an online master's Nursing Administration course.

To simulate the type of ethical and informed decision making required of today's nurse executives, a unique role-playing exercise was developed in a graduate Nursing Administration course. This exercise included evidence-based information about the safety issues inherent in 12-hour nursing shifts. It then explored the decision-making process that a nurse executive would follow to weigh the conflicting concerns of safety and staff satisfaction. A blog format was used for a role-playing exercise in which students were assigned various roles, and the assignment was designed to mimic a roundtable discussion. The final step was to assume the role of the chief nurse executive and make a decision regarding the ethical dilemma of staff satisfaction versus evidence-based safety concerns. Students demonstrated an understanding of acknowledging input from others, as well as the ability to synthesize points on a difficult question.

A randomized trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults.

BACKGROUND: Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest. METHODS: A single-center, randomized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC. The primary outcome measure was hospital stay. RESULTS: A total of 280 per-protocol patients (out of an a priori estimated 320 patients required to demonstrate a 20% relative reduction in hospital stay) were randomly assigned to receive CCPT (no. = 146, 52.1%) or HFCWC (no. = 134, 47.9%). The hospital stay was 12.5 ± 8.8 days for patients randomized to CCPT and 13.0 ± 8.9 days for patients randomized to HFCWC (P = .62). Patient comfort was assessed using a visual analog scale (increasing score reflects greater discomfort) and was statistically greater for patients randomized to CCPT compared to HFCWC (2.2 ± 0.8 vs 1.9 ± 0.8, P = .009). The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC (5.2 ± 4.3 d vs 6.5 ± 5.2 d, P = .051). All other secondary outcomes, including hospital mortality and nosocomial pneumonia, were similar for both treatment groups. CONCLUSIONS: This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients. HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.).

Accountable care organizations: legal concerns.

The Accountable Care Organizations (ACOs) shared savings program has serious concerns about anti-trust and anti-fraud laws. Additionally, ACOs present several other legal concerns relating to the duties and responsibilities of the physician-hospital partnership. The federal regulations hold physicians who participate in the ACO shared savings program to the highest standards of care without offering them protection from liability. The structure and procedures required of ACOs may be detrimental and may significantly impact the liability of its contracting physicians. Therefore, it behooves physicians to obtain legal advice regarding one's estate planning and legal asset protection or wealth management techniques, and to thoroughly review the agreement with one's attorney before signing a contract with an ACO.

'Shedding light' on the challenges faced by Palestinian maternal health-care providers.

OBJECTIVE: to explore the challenges and barriers faced by Palestinian maternal health-care providers (HCPs) to the provision of quality maternal health-care services through a case study of a Palestinian public referral hospital in the Occupied Palestinian Territory. DESIGN AND METHOD: descriptive qualitative study. The data are from a broader study, conducted in 2005 at the same hospital as part of a baseline assessment of maternal health services. PARTICIPANTS: 31 maternal HCPs; nine midwives and 14 nurses and eight doctors. FINDINGS: the quality of care provided for women and infants at this Palestinian public hospital is substandard. The maternal HCPs work within a difficult and resource-constrained environment. ISSUES INCLUDE: high workload, poor compensation, humiliation in the workplace, suboptimal supervision and the absence of professional support and guidance. Midwives are perceived to be at the bottom of the health professional hierarchy. CONCLUSIONS: there is a need for managers and policy makers to enable maternal HCPs to provide better quality care for women and infants during childbirth, through facilitating the roles of midwives and nurses and creating a more positive and resourceful environment. IMPLICATIONS FOR PRACTICE: Palestinian midwives need to increase their knowledge and use evidence-based practices during childbirth. They need to unite and create their own circle of professional support in the form of a Palestinian midwifery professional body.

Exploring the possibility of a common structural model measuring associations between safety climate factors and safety behaviour in health care and the petroleum sectors.

The aim of the present study was to explore the possibility of identifying general safety climate concepts in health care and petroleum sectors, as well as develop and test the possibility of a common cross-industrial structural model. Self-completion questionnaire surveys were administered in two organisations and sectors: (1) a large regional hospital in Norway that offers a wide range of hospital services, and (2) a large petroleum company that produces oil and gas worldwide. In total, 1919 and 1806 questionnaires were returned from the hospital and petroleum organisation, with response rates of 55 percent and 52 percent, respectively. Using a split sample procedure principal factor analysis and confirmatory factor analysis revealed six identical cross-industrial measurement concepts in independent samples-five measures of safety climate and one of safety behaviour. The factors' psychometric properties were explored with satisfactory internal consistency and concept validity. Thus, a common cross-industrial structural model was developed and tested using structural equation modelling (SEM). SEM revealed that a cross-industrial structural model could be identified among health care workers and offshore workers in the North Sea. The most significant contributing variables in the model testing stemmed from organisational management support for safety and supervisor/manager expectations and actions promoting safety. These variables indirectly enhanced safety behaviour (stop working in dangerous situations) through transitions and teamwork across units, and teamwork within units as well as learning, feedback, and improvement. Two new safety climate instruments were validated as part of the study: (1) Short Safety Climate Survey (SSCS) and (2) Hospital Survey on Patient Safety Culture-short (HSOPSC-short). Based on development of measurements and structural model assessment, this study supports the possibility of a common safety climate structural model across health care and the offshore petroleum industry.

A importância da gestão de pessoas para as instituições de saúde / The importance of the management of people for the health institutions

O presente trabalho tem como objetivo destacar a importância da gestão de pessoas dentro das instituições de saúde, em especial dos hospitais, enfatizando aspectos históricos e conceituais do tema. Faz um resgate histórico sobre a administração de recursos humanos e apresenta pontos importantes para o bom desempenho das instituições de saúde relacionada a esse contexto. (AU)

Sustaining the rural workforce: nursing perspectives on worklife challenges.

CONTEXT: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. PURPOSE: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. METHODS: Semi-structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. FINDINGS: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well-being of the nurses and patients. CONCLUSIONS: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.

Emotional debriefing.

In health care, stress and sadness come with the job. Hospitals now recognize that letting clinicians and nonclinicians decompress--through talking groups, counseling or a few minutes of quiet time-is good for the soul and for the quality of patient care.

Parâmetros para o planejamento e dimensionamento da força de trabalho em hospitais gerais / Parameters for planning and dimensioning staff at a general hospital

Introdução: O trabalho sintetiza as diretrizes gerais a serem aplicadas no processo de dimensionamento de pessoal, envolvendo os setores típicos, para o funcionamento de um hospital geral, público, no contexto do Sistema Único de Saúde /São Paulo. Objetivos: sistematizar a metodologia de dimensionamento de pessoal em hospitais gerais; estabelecer indicadores gerais e específicos para o processamento de dimensionamento de pessoal; criar referenciais técnicos para aqueles que pretendem iniciar as atividades e ou avaliação do quadro de pessoal; contribuir com a organização no momento do planejamento e definição do perfil quantitativo e qualitativo de pessoal. Metodologia: o perfil institucional foi tomado como questão principal, adjacente ao estudo das necessidades de saúde da população onde o hospital se insere. Além de salientar, a função tecnológica de referência e contrareferência, no que se refere à integralidade do Sistema de Saúde. Inicialmente, o estudo congregava 15 instituições da Região Metropolitana de São Paulo, das quais cinco eram novas na região, do Estado, três ex - INAMPS (federais), dois que se encontravam sob intervenção estadual e outros cinco que estavam em projeto de recuperação da capacidade instalada. No período, entre 1988 e 2001, intervalo no qual, definiu principais indicadores, abrangendo os 45 hospitais do Estado, além de, um universitário e alguns da esfera municipal. Abordou-se a dimensão política como aspecto obrigatório e foi considerada fundamental para o exame competência técnica da instituição, consoante ao perfil de morbi-mortalidade da população. A segunda etapa metodológica constituiu-se da exploração dos fatores que determinam o modelo assistencial relativos à política de saúde, de pessoal, variáveis gerais e específicas para o planejamento da força de trabalho, quais sejam: ambulatório, setor de urgência e emergência, internação, apoio diagnóstico, apoio técnico e área administrativa. O hospital caracteriza-se pelo funcionamento ininterrupto, propôs-se projeção do índice de segurança técnica, com o objetivo de preencher as necessidades decorrentes de férias, folgas e outras ausências previstas e não previstas. O ensaio do dimensionamento de pessoal tomou como base as áreas assistenciais, apoio diagnóstico e terapêutico, apoio técnico, administrativa, gerenciamento de recursos humanos e apoio administrativo. Conclusão: os indicadores gerais encontrados que podem servir de referência para diversas instituições foram: funcionário / leito: 4,2; pessoal de enfermagem / leito: 1,8; enfermeira / leito: 0,4. A composição geral do quadro de pessoal, como valores médios, foram de: enfermagem 44%, apoio e diagnóstico 20%, apoio técnico 21% e área administrativa 15%. Um estudo detalhado sobre o contexto e a observância de indicadores gerais quanto à demanda de necessidades são definidores críticos, que antecedem à avaliação do quadro ou da etapa de dimensionamento de pessoal.

Introduction: this work synthesizes the guidelines to be applied in the process of dimensioning labor force involving typical sectors and public hospitals to work together with the Healthcare System- Sistema Único de Saúde/ São Paulo. Objectives: to systematize the methodology for dimensioning human resources in a public hospital; to establish general and specific indicators in the process of dimensioning labor forces; to create technical referencials for institutions in a process of planning personal ; to contribute planning as well as a quantitative and qualitative profile of the organization. Methodology: the main aspect considered has been the institutional profile of health care needs in the area within reach of the hospital: reference and cross-reference are also an outstanding factor for the fully integrated Healthcare System. This study considered 15 institutions in the Metropolitan area of São Paulo. Between 1988 and 2001 the main guide-lines for 45 Sate Hospitals and several teaching hospitals were established. There has been a fundamental approach to analyse the competence of the institution regarding the morbidity ­ mortalities profile of the population. Since the institution non-stop a projection of an index ensuring technical security has been proposed, in over to cover for vacations, days-off and other planned or unplanned absences. A test of the staff size has been done, based on data related support, as well as other areas.

Introducción: Este trabajo sintetiza las directrices generales que serán aplicadas en el proceso de dimensión de la fuerza de trabajo, que involucra los sectores típicos, para el funcionamiento de hospitales públicos, en el contexto del Sistema Único de Saúde / São Paulo. Objetivos: Sistematizar la metodologia para dimensionar la fuerza de trabajo en hospitales; establecer indicadores generales y específicos para el proceso de dimensionar la fuerza de trabajo; crear referenciales técnicos para entidades que están en el proceso de planificación para iniciar sus actividades como una institución nueva y para aquellas que ya están en funcionamiento; contribuir con la organización en el momento de planificar y definir el número de personal necesario. Metodología: el perfil institucional fue tomado como tema principal, adyacente al estudio de las necesidades de salud de la población del área de abrangencia del hospital. También se resalta la complementariedad entre la referencia y la contrarreferencia como estrategia para lograr la integralidad del sistema de atención de salud. Inicialmente, este estudio congregaba 15 instituciones de la Región Metropolitana de São Paulo, de los cuales 5 eran nuevos en esta región, tres ex ­ INAMPS (del gobierno central), dos que estaban siendo intervenidos por la Secretaria de Salud del Estado de São Paulo y otros cinco que estaban en proyecto de recuperación de la capacidad instalada. El periodo compreendido entre 1988 y 2001 fue crucial, por que en este intervalo se establecieron los principales indicadores, siendo que posteriormente éstos fueron adaptados. Al terminar este periodo, el estudio abarcó 45 hospitales del Estado de São Paulo, incluyendo un Hospital Universitario y algunos de la esfera municipal. Se abordó la dimensión política como aspecto obligatorio, y se consideró los aspectos fundamentales para el examen de competencia técnica de la institución, de acuerdo con el perfil de morbimortalidad de la población. La segunda etapa metodológica comprendió el estudio de los factores que determinan el modelo asistencial relativos a la política de salud, de personal, variables generales y específicas para la planificación de personal, según las áreas específicas de asistencia, las cuales son: ambulatorio, sector de urgencias y emergencias, hospitalización, apoyo de diagnóstico, apoyo técnico y área administrativa. Por la naturaleza de la institución, con funcionamiento de 24 horas, hay proyección del índice de seguridad técnica, con el objetivo de completar el cuadro de personal necesario para cobrir las vacaciones, días libres y otras ausencias previstas y no previstas. El ensayo para dimensionar el personal tuvo como base las áreas asistenciales, apoyo de diagnóstico y terapéutico, apoyo técnico, administrativo, gestión de recursos humanos y apoyo administrativo. Conclusión: los indicadores generales encontrados que pueden servir de referencia para diferentes instituciones fueron: trabajadores / cama: 4,2; personal de enfermería / cama 1,8; enfermera / cama: 0,4. La composición general del cuadro de personal tuvo una media de valores de: personal de enfermería 44%, apoyo y diagnóstico 20%, apoyo técnico 21% y área administrativa 15%. Un estudio detallado sobre el contexto y la observación de indicadores generales referente a la demanda de necesidades son críticos en la definición de la fuerza de trabajo, que anteceden a la evaluación del cuadro o de la etapa para dimensionar el personal.

Spiritual leadership: a new model.

Recent unethical business practices of some corporations and the overall loss of confidence by the public in corporate leadership have given rise to a unique leadership model--one that focuses on spirituality. "Ninety percent of our diverse American population and health-care workforce have spiritual and religious beliefs. While these beliefs may be mystical, religious, or secular, there are many common patterns that influence change and leadership within our organizations." So says Gary Strack, CHE, president and chief executive officer of Boca Raton (FL) Community Hospital. Strack presented a seminar on the topic at ACHE's 2003 Congress on Healthcare Management.