Prevalence and Characteristics of Non-US-Born and US-Born Health Care Professionals, 2010-2018.

Importance: Immigration to the US results in greater racial/ethnic diversity. However, the contribution of immigration to the diversity of the US health care professional (HCP) work force and its contribution to health care are poorly documented. Objective: To examine the sociodemographic characteristics and workforce outcomes of non-US-born and US-born HCPs. Design, Setting, and Participants: This cross-sectional study used national US Census Bureau data on US-born and non-US-born HCPs from the American Community Survey between 2010 and 2018. Demographic characteristics and occupational data for physicians, advanced practice registered nurses, physician assistants, registered nurses, licensed practical nurses or licensed vocational nurses, and other HCPs were included for analysis. Data were analyzed between December 2020 and February 2021. Exposures: Nativity status, defined as US-born HCP vs non-US-born HCP (further stratified by <10 years or ≥10 years of stay in the US). Main Outcomes and Measures: Annual hours worked, proportion of work done at night, residence in medically underserved areas and populations, and work in skilled nursing/home health settings. Inverse probability weighting of 3 nativity status groups was carried out using logistic regression. F test statistics were used to test across-group differences. Data were weighted using American Community Survey sampling weights. Results: Of a total of 657 455 HCPs analyzed (497 180 [75.5%] women; mean [SD] age, 43.7 [13.0] years; 518 317 [75.6%] White, 54 233 [10.8%] Black, and 60 680 [9.6%] Asian), non-US-born HCPs (105 331 in total) represented 17.3% (95% CI, 17.2%-17.4%) of HCPs between 2010 and 2018. They were older (mean [SD] age, 44.7 [11.6] years) and had more education (75 227 [70.1%] HCPs completed college) compared with US-born HCPs (mean [SD] age, 43.4 [13.3] years; 304 601 [55.2%] completed college). Nearly half of non-US-born HCPs (47 735 [43.0%]) were Asian. In major metropolitan areas, non-US-born HCPs represented 40% or more of all HCPs. Compared with US-born HCPs, non-US-born HCPs with less than 10 years and 10 or more years of stay worked 32.3 hours (95% CI, 19.2 to 45.4 hours) and 71.6 hours (95% CI, 65.1 to 78.2 hours) more per year, respectively. Compared with US-born HCPs, non-US-born HCPs were more likely to reside in areas with shortages of health care professionals (estimated percentage: <10 years, 75.3%; ≥10 years, 62.8% vs US-born, 8.3%) and work in home health settings (estimated percentage: <10 years, 17.5%; ≥10 years, 13.1% vs US-born, 12.8%). Conclusions and Relevance: The contributions of non-US-born HCPs to US health care are substantial and vary by profession. Greater efforts should be made to streamline their immigration process and to harmonize training and licensure requirements.

Presencia de padres en técnicas invasivas en neonatología: perspectiva de los profesionales en España / Presence of parents during invasive techniques in neonatology: A perspective of spanish professionals

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Associação entre absenteísmo e ambiente de trabalho dos técnicos de enfermagem / Asociación entre absentismo y entorno de trabajo de técnicos de enfermería / Association between absentism and work environment of nursing technicians

RESUMO Objetivo analisar se o ambiente de trabalho e as características sociodemográficas e laborais influenciam o absenteísmo de técnicos de enfermagem. Método estudo transversal e correlacional, em unidade de urgência e emergência com técnicos de enfermagem. Aplicado instrumento com dados sociodemográficos e laborais, absenteísmo referido e versão brasileira validada para técnicos de enfermagem do Nursing Work Index Revised (B-NWI-R). Resultados participaram 62 técnicos de enfermagem, predominância do sexo feminino, jovens, trabalho de 36 a 40 horas semanais e turno diurno. Absenteísmo foi referido por 33,87% dos participantes e o ambiente de trabalho foi considerado favorável à prática, com média 2,47. A cada ponto na escala B-NWI-R a chance de absenteísmo aumenta em 2,63 vezes, ou seja, quanto mais desfavorável à prática profissional é o ambiente de trabalho maior é a chance de absenteísmo. Conclusão um ambiente de trabalho desfavorável à prática profissional aumenta a chance de absenteísmo entre os técnicos de enfermagem. Implicações para a prática uma análise do absenteísmo associada ao ambiente de trabalho dos técnicos de enfermagem contribui para que os gerentes de enfermagem criem estratégias para melhorar o ambiente de trabalho.

RESUMEN Objetivo analizar si el entorno laboral y las características sociodemográficas y laborales influyen en el absentismo de los técnicos de enfermería. Método estudio transversal y correlacional, en una unidad de urgencias y emergencias con técnicos de enfermería. Instrumento aplicado con datos sociodemográficos y laborales, ausentismo referido y versión brasileña validada para técnicos de enfermería del Nursing Work Index Revised (B-NWI-R). Resultados participaron 62 técnicos de enfermería, predominantemente mujeres, jóvenes, trabajando de 36 a 40 horas a la semana y turno de día. El ausentismo fue reportado por el 33,87% de los participantes y el ambiente de trabajo se consideró favorable a la práctica, con un promedio de 2,47. En cada punto de la escala B- NWI-R, la posibilidad de absentismo aumenta en 2,63 veces, es decir, cuanto más desfavorable sea la práctica profesional en el entorno laboral, mayores serán las posibilidades de absentismo. Conclusión un ambiente de trabajo desfavorable para la práctica profesional aumenta las posibilidades de absentismo entre los técnicos de enfermería. Implicaciones para la práctica un análisis del absentismo asociado con el ambiente de trabajo de los técnicos de enfermería ayuda a los gerentes de enfermería a crear estrategias para mejorar el ambiente de trabajo.

ABSTRACT Objective to analyze whether the work environment and socio-demographic and work characteristics influence the absenteeism of nursing technicians. Method a cross-sectional and correlational study, conducted in an urgency and emergency unit with nursing technicians. Instrument applied with sociodemographic and work data, referred absenteeism and validated Brazilian version for nursing technicians of the Nursing Work Index Revised (B-NWI-R). Results a total of 62 nursing technicians participated, predominantly female, young, working from 36 to 40 hours a week and day shift. Absenteeism was reported by 33.87% of the participants and the work environment was considered favorable to the practice, with a mean of 2.47. At each point on the B-NWI-R scale, the chance of absenteeism increases by 2.63 times, that is, the more unfavorable the professional practice is to the work environment, the greater the chance of absenteeism. Conclusion a work environment unfavorable for the professional practice increases the chance of absenteeism among nursing technicians. Implications for the practice an analysis of absenteeism associated with the work environment of nursing technicians helps nursing managers to create strategies to improve the work environment.

Visão dos enfermeiros e técnicos de enfermagem sobre a importância da higiene bucal em pacientes internados / The view of nurses and nursing technicians about the importance of oral hygiene in admitted patients

Objetivos: avaliar qual a visão de enfermeiros (E) e técnicos de enfermagem (TE) sobre a importância dos cuidados em higiene bucal de pacientes internados; verificar se a remoção do biofilme dental é realizada nos pacientes; e comparar a visão destes profissionais em dois hospitais de Passo Fundo, RS. Materiais e método: a seleção dos profissionais E e TE foi feita através de randomização eletrônica. A coleta dos dados foi através de questionário, aplicado na forma de entrevista. Os dados obtidos foram tabulados (Excel) e apresentados em percentuais. Foram entrevistados 31 TE e 20 E, distribuídos no Hospital de Clínicas (TE=15; E=10) e no Hospital São Vicente de Paulo (TE=16; E=10). Os profissionais eram das unidades de pediatria, oncologia, emergência, maternidade, posto de atendimento geral e outros. Resultados: todos os profissionais consideraram importante a higiene bucal dos pacientes, mas a higienização e a avaliação da cavidade bucal não são realizadas em todas as situações. Os técnicos de enfermagem e os enfermeiros de ambos os hospitais consideraram muito importante a higiene bucal dos pacientes hospitalizados. Conclusão: a realização da remoção do biofilme dental, embora relevante, não é realizada com a frequência preconizada para a manutenção da saúde bucal dos pacientes, reforçando a necessidade do profissional cirurgião-dentista na equipe hospitalar.(AU)

This study aimed to evaluate how is the view of the nurses (N) and technicians´ (T) about the importance of the oral hygiene to admitted patients; to check if the dental biofilm control methods are done in the patients; and to compare the professionals' view of these professionals in two hospitals, in Passo Fundo, RS. The N ant T professionals' selection was made by electronic randomization. The data collect was performed through a questionnaire applied as an interview. Thirty-one T and twenty N were interviewed, distributed at the Clinical Hospital (T=15; N=10) and at the São Vicente de Paulo Hospital (T=16; N.=10). The professionals were from the pediatrics, oncology, emergency, maternity, general care and other units. All of them disclaimed important the patients' oral hygiene, but hygiene and oral cavity evaluation were not made always. Nursing technicians and nurses from both hospitals consider the oral hygiene of admitted patients very important. The research showed that dental biofilm removal, although relevant, it is not performed as often as recommended to maintain the oral health of patients, stepping up the Dentist professional in the hospitalar team.(AU)

Leadership and job satisfaction in the Mobile Emergency Care Service context.

OBJECTIVE: to evaluate the correlation between the practice of Coaching Leadership performed by nursing coordinators and job satisfaction, in the self-perception of coordinators and the perception of nursing technicians of the Mobile Emergency Care Service. METHOD: a descriptive, correlational study that used the Questionnaire on Self-Perception of the Nurse in the Exercise of Leadership to measure the self-perception of leadership of the eleven nursing coordinators and the Questionnaire on Nursing Technician Perception in the Exercise of Leadership to verify the perception of 155 nurse technicians. The Job Satisfaction Questionnaire assessed job satisfaction in both categories. Correlations among instrument domains were determined using the Spearman test (p<0.05) and the association was analyzed. RESULTS: the Coaching Leadership exercise correlated with job satisfaction (p-value=0.001), both in the self-perception of nursing coordinators, with high correlation (Spearman coefficient - (0.835), and in the perception of nursing technicians, with moderate association (Spearman coefficient - 0.678). CONCLUSION: coaching Leadership showed a positive correlation with job satisfaction, marked by mutual trust, continuous interaction between nurse and nursing technicians, and the pursuit of professional and personal development.

Essential Long-Term Care Workers Commonly Hold Second Jobs and Double- or Triple-Duty Caregiving Roles.

OBJECTIVES: Long-term care (LTC) facilities are particularly dangerous places for the spread of COVID-19 given that they house vulnerable high-risk populations. Transmission-based precautions to protect residents, employees, and families alike must account for potential risks posed by LTC workers' second jobs and unpaid care work. This observational study describes the prevalence of their (1) second jobs, and (2) unpaid care work for dependent children and/or adult relatives (double- and triple-duty caregiving) overall and by occupational group (registered nurses [RNs], licensed practical nurses [LPNs], or certified nursing assistants [CNAs]). DESIGN: A descriptive secondary analysis of data collected as part of the final wave of the Work, Family and Health Study. SETTING: Thirty nursing home facilities located throughout the northeastern United States. PARTICIPANTS: A subset of 958 essential facility-based LTC workers involved in direct patient care. MEASUREMENTS: We present information on LTC workers' demographic characteristics, health, features of their LTC occupation, additional paid work, wages, and double- or triple-duty caregiving roles. RESULTS: Most LTC workers were CNAs, followed by LPNs and RNs. Overall, more than 70% of these workers agreed or strongly agreed with this statement: "When you are sick, you still feel obligated to come into work." One-sixth had a second job, where they worked an average of 20 hours per week, and more than 60% held double- or triple-duty caregiving roles. Additional paid work and unpaid care work characteristics did not significantly differ by occupational group, although the prevalence of second jobs was highest and accompanying work hours were longest among CNAs. CONCLUSION: LTC workers commonly hold second jobs along with double- and triple-duty caregiving roles. To slow the spread of COVID-19, both the paid and unpaid activities of these employees warrant consideration in the identification of appropriate clinical, policy, and informal supports. J Am Geriatr Soc 68:1657-1660, 2020.

Occupational differences in workers' compensation indemnity claims among direct care workers in Minnesota nursing homes, 2005-2016.

BACKGROUND: Nursing assistants have one of the highest injury rates in the U.S., but few population-based studies assess differential injury risk by occupation in nursing homes. This statewide study assessed differences in musculoskeletal disorders (MSDs) and patient handling injuries among direct care workers in Minnesota nursing homes. METHODS: Indemnity claims from the Minnesota workers' compensation database were matched to time at risk from the Minnesota Nursing Home Report Card to estimate 2005 to 2016 injury and illness claim rates for certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs). Associations between occupation and claim characteristics were assessed using multivariable regression modeling. RESULTS: Indemnity claim rates were 3.68, 1.38, and 0.69 per 100 full-time equivalent workers for CNAs, LPNs, and RNs, respectively. Patient handling injuries comprised 62% of claims. Compared to RNs, CNAs had higher odds of an indemnity claim resulting from an MSD (odds ratio [OR] = 1.67; 95% confidence interval [CI], 1.31-2.14) or patient handling injury (OR = 1.89; 95% CI, 1.47-2.45) as opposed to another type of injury or illness. CNAs had lower odds of receiving temporary and permanent partial disability benefits and higher odds of receiving a stipulation settlement. CONCLUSIONS: CNAs in Minnesota nursing homes are at heightened risk for lost time MSDs and patient handling injuries. Claims filed by CNAs are more frequently settled outside the regular workers' compensation benefit structure, an indication that the workers' compensation system is not providing adequate and timely benefits to these workers.

Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics.

BACKGROUND: The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha. METHODS: A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation. RESULTS: The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82. CONCLUSIONS: The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples. TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).

A Profile of Regulated Nurses Employed in Canadian Long-Term Care Facilities.

ABSTRACTRegistered nurses (RNs) and licensed practical nurses (LPNs) provide the skilled component of nursing care in Canadian residential long-term care facilities, yet we know little about this important workforce. We surveyed 309 RNs and 448 LPNs from 91 nursing homes across Western Canada and report descriptively on their demographics and work and health-related outcomes. LPNs were significantly younger than RNs, worked more hours, and had less nursing experience. LPNs also experienced significantly more dementia-related responsive behaviours from residents compared to RNs. Younger LPNs and RNs reported significantly worse burnout (emotional exhaustion) and poorer mental health compared to older age groups. Significant differences in demographics and work- and health-related outcomes were also found within the LPN and RN samples by province, region, and owner-operator model. These findings can be used to inform important policy decisions and workplace planning to improve quality of work life for nurses in residential long-term care facilities.

The Relationship Between Reported Staffing and Expenditures in Nursing Homes.

Dramatic improvements in reported nursing home quality, including staffing ratios, have come under increased scrutiny in recent years because they are based on data self-reported by nursing homes. In contrast to other domains, the key mechanism for real improvement in the staffing ratios domain is clearer: to improve scores, nursing homes should increase staffing expenditures. We analyze the relationship between changes in expenditures and reported staffing quality pre- versus post the 5-star rating system. Our results show that the relationship between expenditures and licensed practical nurse staffing is weaker in the post-5-star period, overall, and across subgroups; furthermore, there is a weaker relationship between expenditures and registered nurse staffing among for-profit facilities with a high share of Medicaid residents in the post-5-star period. The weaker relationship between staffing expenditures and staffing scores in the post-5-star era underscores the potential for gaming of the self-reported staffing scores and the need for more reliable sources.

Practical Nurses' Lived Experience of Returning to School.

The lived experience of licensed practical nurses (LPNs) pursuing Bachelor of Nursing (BN) education is not commonly studied in Canada. The aim was to understand the transition experience of LPNs who bridged into a BN program. Max van Manen's phenomenological methodology was used through use of a semistructured interview guide to explore the lived experience of LPNs who pursued baccalaureate nursing education. Five themes were found: seeking advancement; stepping back into the student role; juggling work, school, and family; struggling to be understood; and seeing things differently. In summary, LPN-to-BN students have a well-developed sense of identity as nurses. These students can benefit from a specifically designed, stand-alone bridge course to situate them within a BN program that leads to successful fulfillment of entry-to-practice competencies for RN licensure.

CE: Original Research: Advance Care Planning: An Exploration of the Beliefs, Self-Efficacy, Education, and Practices of RNs and LPNs.

: Objective: This study compared the advance care planning (ACP)-related beliefs, sense of self-efficacy, education, and practices of RNs and LPNs. METHODS: Data were extrapolated from a larger multisite study that was conducted across seven counties in one midwestern state. The sample consisted of RNs and LPNs working in 29 urban skilled nursing facilities in zip code areas with greater than 10% African American residents. The survey tool, a self-administered written questionnaire, gathered data on participants' demographics and ACP-related beliefs, sense of self-efficacy, education, and practices. The two main outcome variables were the percentage of residents with whom a nurse discussed ACP and the timing of the most recent such discussion. RESULTS: A total of 136 RNs and 178 LPNs completed the survey. Multivariate mixed-model analysis of the two main outcome variables showed that negative beliefs were not significantly associated with the percentage of residents with whom nurses discussed ACP but were significantly associated with the timing of the most recent ACP discussion. Having higher levels of ACP-related self-efficacy and education were significantly and positively associated with both outcome variables. RNs and LPNs did not differ significantly in their ACP-related beliefs, but RNs reported significantly higher levels of self-efficacy and education than LPNs did. CONCLUSIONS: There has been a paucity of research comparing RNs and LPNs regarding their ACP practices in skilled nursing facilities. Better education and policies that empower nurses to take a more active role are critical to increasing conversations about ACP. Further research exploring how the complementary roles of RNs and LPNs can be used to improve ACP processes and inform ACP policies is needed.

Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals.

BACKGROUND: Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern. PURPOSE: The purpose of this study was to compare reports of missed nursing care by two types of nurses - registered nurses and practical nurses - in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles. METHODS: This was a cross-sectional descriptive study using the MISSCARE Survey-Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland. FINDINGS: A t-test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) [t(541) = 5.703, p < 0.001]. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting [t(299) = 2.210, p = 0.028]. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons. CONCLUSIONS: The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.

An untapped resource in the nursing workforce: Licensed practical nurses who transition to become registered nurses.

BACKGROUND: A more diverse registered nurse (RN) workforce is needed to provide health care in North Carolina (NC) and nationally. Studies describing licensed practical nurse (LPN) career transitions to RNs are lacking. PURPOSE: To characterize the occurrence of LPN-to-RN professional transitions; compare key characteristics of LPNs who do and do not make such a transition; and compare key characteristics of LPNs who do transition in the years prior to and following their transition. METHODS: A retrospective design was conducted using licensure data on LPNs from 2001 to 2013. Cohorts were constructed based on year of graduation. FINDINGS: Of 39,398 LPNs in NC between 2001 and 2013, there were 3,161 LPNs (8.0%) who had a LPN-to-RN career transition between 2001 and 2013. LPNs were more likely to transition to RN if they were male; from Asian, American Indian, or other racial groups; held an associate or baccalaureate degree in their last year as an LPN (or their last year in the study if they did not transition); worked in a hospital inpatient setting; worked in the medical-surgical nursing specialty; and were from a rural area. DISCUSSION: Our findings indicate that the odds of an LPN-to-RN transition were greater if LPNs were: male; from all other racial groups except white; of a younger age at their first LPN licensure; working in a hospital setting; working in the specialty of medical-surgical nursing; employed part-time; or working in a rural setting during the last year as an LPN. CONCLUSION: This study fills an important gap in our knowledge of LPN-to-RN transitions. Policy efforts are needed to incentivize: LPNs to make a LPN-to-RN transition; educational entities to create and communicate curricular pathways; and employers to support LPNs in making the transition.

Workplace Violence and Training Required by New Legislation Among NJ Nurses.

OBJECTIVE: The aim of this study was to examine nurses' knowledge of the state of New Jersey (NJ) Violence Prevention in Health Care Facilities Act, workplace violence training, and experience with workplace violence. METHODS: In 2013, 309 (22.5% response rate) nurses returned a mailed survey. Univariate and multivariate analyses were conducted. RESULTS: Ninety percent of respondents were female. When the perpetrator was a patient or a family member, the respondents experienced verbal abuse the most (57.8%), followed by threats (52.3%), and physical assault (38.3%). Respondents who had heard of the regulation (89.6%) received a higher proportion of training than those who had not heard of the regulation (57.9%) (P < 0.0001). CONCLUSIONS: Nurses who received at least 80% of the required training components were more likely to feel more secure at work, suggesting that training is an important tool to address workplace violence.

Association of Temporal Variations in Staffing With Hospital-Acquired Pressure Injury in Military Hospitals.

To more precisely evaluate the effects of nurse staffing on hospital-acquired pressure injury (HAPI) development, data on nursing care hours per patient day (NCHPPD), nursing skill mix, patient turnover (i.e., admissions, transfers, and discharges), and patient acuity were merged with patient information from pressure injury prevalence surveys that were collected annually for the Military Nursing Outcomes Database (MilNOD) project. The MilNOD included staffing and adverse events from 56 medical-surgical, stepdown, and critical care units in 13 military hospitals over a 4-year-period. Data on 1,643 patients were analyzed with Cox proportional hazards models and generalized estimating equations. Staffing was not associated with pressure injuries in stepdown or critical care patients. However, among the 1,104 medical-surgical patients, higher licensed practical nurse (LPN) nursing care hours per patient day (NCHPPD) 3 days and 1 week prior to the HAPI discovery date were associated with fewer HAPI (HR 0.27, p < .001), after controlling for patient age, Braden mobility score, and albumin level. Neither total staff number, nor RN NCHPPD, nor the proportion of staff who were RNs (RN skill mix) were associated with HAPI. These findings suggest that on military medical-surgical units, LPNs play a major role in HAPI prevention. Although the national trend in acute care is to staff hospital units with more RNs and patient care technicians, and fewer LPNs, hospitals should reconsider LPNs as valuable members of the nursing care team. © 2016 Wiley Periodicals, Inc.

Percepções de profissionais de enfermagem acerca da integração do técnico de enfermagem na sistematização da assistência / Perceptions of nursing professionals regarding the integration of nursing technicians in the systematization of care

Objetivo: Descrever as percepções de docentes e de profissionais da assistência acerca da integração do técnico de enfermagem na Sistematização da Assistência de Enfermagem (SAE). Métodos: Trata-se de estudo descritivo, de abordagem qualitativa. Participaram sete docentes e 13 técnicos de enfermagem vinculados a um hospital universitário do Nordeste brasileiro. A coleta de dados ocorreu a partir da técnica do grupo focal e o conteúdo textual foi submetido à análise lexicográfica. Resultados: As percepções dos docentes resultaram na análise de quatro classes: potencialidades da integração do técnico na SAE; entraves e fragilidades; formação dos técnicos; e ensino em serviço como primordial. Quanto às opiniões dos técnicos, três classes foram analisadas: representações subjetivas; potencialidades da SAE; e possibilidades de contribuição do técnico de enfermagem. Conclusão: Docentes e profissionais da assistência descrevem as potencialidades da integração do técnico de enfermagem na SAE e a reconhecem como condicionante para efetivação deste método de trabalho.

Nursing Home Registered Nurses' and Licensed Practical Nurses' Knowledge of Causes of Falls.

Reducing falls in nursing homes requires a knowledgeable nursing workforce. To test knowledge, 8 validated vignettes representing multifactorial fall causes were administered to 47 nurses from 3 nursing homes. Although licensed practical nurses scored higher than registered nurses in individual categories of falls, when we computed the average score of all 8 categories between groups of registered nurses and licensed practical nurses, registered nurses scored higher (F = 4.106; P < .05) in identifying 8 causal reasons for older adults to fall.

Job demands and job strain as risk factors for employee wellbeing in elderly care: an instrumental-variables analysis.

BACKGROUND: The association between psychosocial work environment and employee wellbeing has repeatedly been shown. However, as environmental evaluations have typically been self-reported, the observed associations may be attributable to reporting bias. METHODS: Applying instrumental-variable regression, we used staffing level (the ratio of staff to residents) as an unconfounded instrument for self-reported job demands and job strain to predict various indicators of wellbeing (perceived stress, psychological distress and sleeping problems) among 1525 registered nurses, practical nurses and nursing assistants working in elderly care wards. RESULTS: In ordinary regression, higher self-reported job demands and job strain were associated with increased risk of perceived stress, psychological distress and sleeping problems. The effect estimates for the associations of these psychosocial factors with perceived stress and psychological distress were greater, but less precisely estimated, in an instrumental-variables analysis which took into account only the variation in self-reported job demands and job strain that was explained by staffing level. No association between psychosocial factors and sleeping problems was observed with the instrumental-variable analysis. CONCLUSIONS: These results support a causal interpretation of high self-reported job demands and job strain being risk factors for employee wellbeing.

Effects of staffing choices on collaborative care for depression at primary care clinics in Minnesota.

OBJECTIVE: This study assessed associations between staffing of a collaborative care program for depression and enrollment in the program and remission rates. METHODS: Data were collected from depression care registries at 63 primary care clinics that participated in the initiative through early 2012. Project leaders at the 12 medical groups that operate the clinics were surveyed about the background of care managers and clinic characteristics. Generalized linear mixed models assessed associations of care manager background and configuration of staffing with enrollment and remission rates. RESULTS: Enrollment was higher (p=.050) and there was a trend toward higher remission rates (p=.105) at clinics where care managers were dedicated exclusively to depression care. No differences in outcomes were obtained by registered nurses versus certified medical assistants and licensed practical nurses. CONCLUSIONS: Hiring dedicated paraprofessional care managers may maximize the cost-effectiveness of collaborative care programs and should be supported by regulations and reimbursement policies.