Pediatric Epilepsy Readmissions: The Who, When, and Why.

BACKGROUND: Prior studies have demonstrated a pediatric epilepsy readmission rate of 6% to 10% but have not described details of the readmitted patients. We report the characteristics of pediatric patients admitted for epilepsy who were readmitted to the hospital within 30 days of discharge. METHODS: An interdisciplinary team was established to individually review and characterize the 30-day readmissions of patients admitted for epilepsy from May 2014 to October 2016. The team contained both inpatient and outpatient neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians. RESULTS: Over a 30-month period we had an all-cause 30-day readmission rate of 8.0%, which was 219 pediatric epilepsy readmissions from 169 patients. We found that 21.5% of readmissions were scheduled, 37% were for progression of chronic epilepsy, 9.6% were for recently diagnosed epilepsy, and 14.6% were for unrelated diagnoses. We classified 21.5% of readmissions as preventable and 64.9% as not preventable. Thirty-five percent of readmissions occurred within seven days of the initial discharge, including 29 of 47 (61.7%) preventable readmissions. The most common reasons for preventable readmissions were problems with the discharge care plan or medication management. CONCLUSIONS: We demonstrate that 21.5% of pediatric epilepsy readmissions were scheduled and 21.5% were judged to be preventable. The majority of preventable readmissions occurred within seven days of index discharge. Characterizing epilepsy readmissions is the first step in being able to reduce readmissions.

Achieving 80% BSN by 2020: Chief Nurse Executive Role and ANCC Influence.

OBJECTIVES: The aim of this study was to understand current education level of hospital nurses and strategies used by Kentucky's chief nurse executives (CNEs) to encourage academic progression in their RN workforce. BACKGROUND: The Institute of Medicine and American Nurses Credentialing Center called for 80% of RNs to be educated with a minimum of a BSN. CNEs have a key role in achieving that goal. METHODS: An electronic survey was administered in fall 2013. Fifty-two Kentucky CNEs responded. RESULTS: No hospitals in Kentucky met the BSN target. Sixty-two percent of CNEs planned to achieve 80% BSN nurses by 2020. Teaching status, hiring preferences, goals for increasing percentage of BSN nurses, and processes to facilitate advancement of nurses prepared at the associate degree level were associated with pursuit or achievement of Pathway to Excellence® or Magnet® designation. In addition to policies to support increasing educational levels, incentives offered included tuition reimbursement, career advancement, time off, and academic partnerships. CONCLUSION: Increasing the proportion of BSN-prepared nurses should be a priority for CNEs. Strategies to facilitate that goal are explored. From these data, a large number of CNEs (38%) do not have a goal to achieve the recommended levels of BSN nurses. Further education and support in the rural hospitals in Kentucky are indicated to support this recommendation.

Nurse managers describe their practice environments.

Hospital work environments that support the professional practice of nurses are critical to patient safety. Nurse managers are responsible for creating these professional practice environments for staff nurses, yet little is known about the environments needed to support nurse managers. Domains of nurse managers' practice environment have recently been defined. This is a secondary analysis of 2 cross-sectional studies of organizational characteristics that influence nurse manager practice. Content analysis of the free text comments from 127 nurse managers was used to illustrate the 8 domains of nurse managers' practice environments. Nurse managers valued time spent with their staff; therefore, workloads must permit meaningful interaction. Directors demonstrated trust when they empowered nurse managers to make decisions. Administrative leaders should build patient safety cultures on the basis of shared accountability and mutual respect among the health care team. The expectations of nurse managers have greatly expanded in the volume and complexity of direct reports, patient care areas, and job functions. The nurse managers in this analysis reported characteristics of their practice environments that limit their role effectiveness and may negatively impact organizational performance. Further research is needed to understand the effects of nurse managers' practice environments on staff and patient outcomes.

The nurse manager practice environment scale: development and psychometric testing.

OBJECTIVES: The objectives of this study were to develop and test a scale designed to describe and assess nurse managers' practice environments. BACKGROUND: Creating practice environments supporting workers at all levels is critical to achieving excellent patient, staff, and organizational outcomes. Scales are available to assess staff nurses' practice environment; however, no comparable scale for nurse managers exists. METHODS: A cross-sectional design using an electronic survey was administered to nurse managers in 25 hospitals in 9 health systems from 6 states. RESULTS: Exploratory factor analysis with a varimax rotation produced a final solution of 44 items loading in 8 domains. Cronbach's α's ranged from .72 to .97. Mean scores ranged from 3.92 to 4.99 on a 6-point Likert scale. CONCLUSIONS: The scale demonstrated adequate psychometric properties and warrants further use and testing. Understanding the nurse manager practice environment may reveal insights to guide opportunities to improve organizational performance.