Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing.

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.

Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis.

Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.

Analysis of the guiding rules of the nurse technician's practice in Brazil.

OBJECTIVES: to analyze the normative bases that guide the nurse technician's practice, clarifying how the performance of this category happens. METHODS: this is a qualitative study of exploratory and descriptive nature and of documentary type, held on the basis of the resolutions of the Brazilian Federal Nursing Council (Cofen). From a total of 364 resolutions published from 1975 to 2018, 15 accounted for the objective of the study and were therefore selected. RESULTS: this study systematized two analytical categories: areas of practice of the nurse technician, according to Cofen resolutions; and description of the professional's activities based on the resolutions. FINAL CONSIDERATIONS: the analysis of the normative bases that guide the nurse technician's practice leads to the conclusion of a possible frailty of theoretical and normative content to justify the practice of these professionals.

Analysis of the guiding rules of the nurse technician's practice in Brazil / Análisis de las normativas que guían la práctica del técnico de enfermería en Brasil / Análise das normativas orientadoras da prática do técnico de enfermagem no Brasil

ABSTRACT Objectives: to analyze the normative bases that guide the nurse technician's practice, clarifying how the performance of this category happens. Methods: this is a qualitative study of exploratory and descriptive nature and of documentary type, held on the basis of the resolutions of the Brazilian Federal Nursing Council (Cofen). From a total of 364 resolutions published from 1975 to 2018, 15 accounted for the objective of the study and were therefore selected. Results: this study systematized two analytical categories: areas of practice of the nurse technician, according to Cofen resolutions; and description of the professional's activities based on the resolutions. Final Considerations: the analysis of the normative bases that guide the nurse technician's practice leads to the conclusion of a possible frailty of theoretical and normative content to justify the practice of these professionals.

RESUMEN Objetivos: evaluar los fundamentos de las normativas que guían la práctica del profesional técnico de enfermería para aclarar cómo ocurre la actuación de esa categoría. Métodos: se trata de un estudio de enfoque cualitativo, de naturaleza exploratoria y descriptiva, de tipo documental, realizado con base en las resoluciones del Consejo Federal de Enfermería. De un total de 364 resoluciones publicadas en el período de 1975 a 2018, se seleccionaron 15 que cumplían con el objetivo del estudio. Resultados: se sistematizaron dos categorías analíticas: el nivel de actuación del técnico de enfermería, según exponen las resoluciones del Consejo Federal de Enfermería, y la descripción de las actividades del profesional con base en estas resoluciones. Consideraciones Finales: el análisis de los fundamentos de las normativas que guían la práctica del técnico de enfermería apunta a una posible debilidad de contenido teórico y normativo para fundamentar la práctica de estos profesionales.

RESUMO Objetivos: analisar os fundamentos normativos que orientam a prática do profissional técnico de enfermagem, esclarecendo como se dá a atuação dessa categoria. Métodos: trata-se de um estudo de abordagem qualitativa, de natureza exploratório-descritiva, do tipo documental, realizado com base nas resoluções do Conselho Federal de Enfermagem. De um total de 364 resoluções publicadas no período de 1975 a 2018, foram selecionadas 15 que atenderam ao objetivo do estudo. Resultados: foram sistematizadas duas categorias analíticas: âmbitos de atuação do técnico de enfermagem, segundo as resoluções do Conselho Federal de Enfermagem, e descrição das atividades do profissional com base nas resoluções. Considerações Finais: a análise dos fundamentos normativos que orientam a prática do técnico de enfermagem guia para a conclusão de possível fragilidade de conteúdo teórico e normativo para fundamentar a prática desses profissionais.

The Government response to the consultation on nursing associates.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a recently published report from the Government on the response to proposals concerning the regulation of nursing associates in England.

Intersecting Policy Contexts of Employment-Related Geographical Mobility of Healthcare Workers: The Case of Nova Scotia, Canada.

Mobility and movement is an increasingly important part of work for many, however, Employment-Related Geographical Mobility (ERGM), defined as the extended movement of workers between places of permanent residence and employment, is relatively understudied among healthcare workers. It is critical to understand the policies that affect ERGM, and how they impact mobile healthcare workers. We outline four key intersecting policy contexts related to the ERGM of healthcare workers, focusing on the mobility of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Continuing Care Assistants (CCAs) in Nova Scotia: international labour mobility and migration; interprovincial labour mobility; provincial credential recognition; and, workplace and occupational health and safety.

Regulating the nursing associate profession.

Emeritus Professor Alan Glasper, University of Southampton, discusses the Government's consultation on changes to the Nursing and Midwifery Order 2001 and the legislation to regulate nursing associates.

[The new methods to define the staffing requirements for doctors,nurses and nurses aides: an example of their implementation in an Italian hospital]. / Le nuove metodologie di valutazione del fabbisognodel personale infermieristico, medico e di supporto: un esempio di applicazione.

. 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.

State Regulation of Medication Administration by Unlicensed Assistive Personnel in Residential Care and Adult Day Services Settings.

Residential care settings and adult day services are two community-based care options used by older adults with chronic health conditions. Most states have regulatory provisions that allow unlicensed assistive personnel (UAP) to administer medications. The current national policy study examined state regulations to identify which states permit UAP to administer medications, as well as staffing and training requirements. Key findings include states lack clear and adequate provisions for nurse oversight of UAP who administer medications, although adult day service regulations provide a greater level of nurse oversight than residential care settings. Specifically, 32 states require residential care to hire a nurse, but only six include provisions regarding nurse availability (e.g., on-call, on-site, number of hours). In contrast, 10 of 20 states that require adult day service programs to hire a nurse provide availability provisions. Nurse oversight of UAP is an important means of assuring quality care and reducing errors; thus, state regulatory agencies might need to strengthen nurse oversight provisions. [Res Gerontol Nurs. 2016; 9(5):209-222.].

[Involvement of healthcare assistants in nursing procedures]. / La collaboration de l'aide-soignante aux actes de l'infirmière.

Healthcare assistants are authorised to perform nursing procedures in accordance with regulated conditions. They do not perform their functions autonomously but carry out their actions within the framework of the nurse's responsibilities.

Legal advice. Richard Griffith on the Mental Capacity Act.

Frequently, I am asked by healthcare assistants (HCAs) what the Mental Capacity Act 2005 has to do with their practice as they are not concerned with formal assessments of decision-making capacity or determinations of patients' best interests.

Opinion piece: Regulation of nursing assistants: A critical international issue?

Abstract Health care or nursing assistants are valuable members of health care teams who undertake a wide range of tasks, contribute to meeting the increasingly complex healthcare needs of patients and have various levels of training. However, they are not subject to regulation in many countries. If training and regulation are pre-requisites for ensuring the standards of care delivered by registered nurses, then this must also apply to nursing assistants. Regulation ensures the need for on-going education and development which is critical to maintaining and refreshing the values underpinning compassionate care for both nursing assistants and registered nurses.