Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Virtual site visits - an emerging option for experiential quality assurance.

BACKGROUND AND PURPOSE: Site visits are a valuable tool for experiential quality assurance. There is sparse literature regarding the use of a virtual modality for completion of site visits. This manuscript describes the experience of using of onsite and virtual site visits, including benefits and limitations of each approach, by two pharmacy experiential programs. EDUCATIONAL ACTIVITY AND SETTING: Each experiential program utilizes both virtual and onsite visits to assess site quality, provide preceptor development, and connect with sites and preceptors. Information gathered and documentation processes are similar for both institutions for both visit modalities. The two pharmacy institutions differ in size, geographical location, number of experiential sites, and experiential department structure. FINDINGS: Based on site evaluator feedback from the two institutions, both visit modalities achieved the goals of evaluating sites for quality, fostering relationships with preceptors, and affording opportunities to provide preceptor development. Positive features of virtual site visits were increased flexibility with scheduling, expanded participation and engagement, increased efficiency, and decreased cost. Drawbacks noted with virtual site visits were challenges touring the site, decreased ability to observe group dynamics and culture, and participant multi-tasking. SUMMARY: A virtual approach to completing experiential site visits achieved programmatic goals. Utilizing a combination of virtual and onsite visits may facilitate a customized approach to navigating the advantages and disadvantages of each modality.

Patient perspective of medication information desired and barriers to asking pharmacists questions.

OBJECTIVES: To identify information patients want from a community pharmacist with new and refill prescription dispensing, examine how this varies across certain patient characteristics, and identify perceived barriers to asking pharmacists' questions. DESIGN: Cross-sectional study. SETTING: Six states (Wyoming, Colorado, Nebraska, Utah, Montana, and Arizona), from January 2006 to August 2008. PARTICIPANTS: Convenience sample of 600 patients or caregivers at community pharmacies. INTERVENTION: Brief, face-to-face, structured interviews. MAIN OUTCOME MEASURES: Information desired by patients when receiving new and refill prescriptions and reasons why patients would not ask pharmacists medication-related questions. RESULTS: Information most often desired at first medication dispensing was adverse effects (58.2%), basic instructions (32.6%), and drug interactions (31%). Less than 9% of patients stated no need for pharmacist-provided information or that written information sufficed. Younger (t = 4.81, P < 0.001) and more educated (X2 = 4.385, P = 0.036) patients were more likely to indicate a desire for adverse effect information than older or less educated patients. When asked about refills, nearly one-half reported wanting information beyond how many refills remain. Of patients, 15% wanted a review of information given when originally dispensed. A review of information was more often desired by patients with less than or equal to a high school education (X2 = 7.830, P < 0.01). Overall, information during refill dispensing was desired more often by those with less education (X2 = 4.786, P = 0.029). CONCLUSION: These results support revisiting current pharmacy practice and practice laws about refill counseling and risk information provision, with greater potential implications for less educated individuals.

Student-Valued Measurable Teaching Behaviors of Award-Winning Pharmacy Preceptors.

OBJECTIVE: To identify specific preceptor teaching-coaching, role modeling, and facilitating behaviors valued by pharmacy students and to develop measures of those behaviors that can be used for an experiential education quality assurance program. METHODS: Using a qualitative research approach, we conducted a thematic analysis of student comments about excellent preceptors to identify behaviors exhibited by those preceptors. Identified behaviors were sorted according to the preceptor's role as role model, teacher/coach, or learning facilitator; measurable descriptors for each behavior were then developed. RESULTS: Data analysis resulted in identification of 15 measurable behavior themes, the most frequent being: having an interest in student learning and success, making time for students, and displaying a positive preceptor attitude. Measureable descriptors were developed for 5 role-modeling behaviors, 6 teaching-coaching behaviors, and 4 facilitating behaviors. CONCLUSION: Preceptors may need to be evaluated in their separate roles as teacher-coach, role model, and learning facilitator. The developed measures in this report could be used in site quality evaluation.

Rework the workload.

Kindred Healthcare, Inc., the nation's largest full-service network of long-term acute care hospitals, initiated a 3-year strategic plan to re-evaluate its workload management system. Here, follow the project's most important and difficult phase--designing and implementing the patient classification system.

Pharmacy students' application of knowledge from the classroom to introductory pharmacy practice experiences.

OBJECTIVE: To determine whether and how pharmacy students used knowledge learned in the classroom during their introductory pharmacy practice experiences (IPPEs) in community and hospital settings. DESIGN: To reinforce course concepts and make connections between coursework and practice, students documented examples of how knowledge from first-year courses was used in IPPEs. ASSESSMENT: Data submitted were categorized by classroom-based pharmacy course, including the frequency with which each course was cited. For community practice experiences, most student examples of knowledge application related to the self-care therapeutics course, pharmacy practice laboratory course, and dose form/compounding laboratory courses. Hospital IPPE examples were most frequently based on the pharmaceutical calculations course, physiology/pathophysiology course, medicinal chemistry course, and pharmacy practice laboratory course. CONCLUSION: All prior classroom-based pharmacy courses were cited by students as being useful during IPPEs, although some were more frequently cited than others. This activity provided useful programmatic assessment data.

The capacity ratio as a measure of solvency in experiential education.

OBJECTIVE: To determine the utility of the capacity ratio to measure and compare solvency in experiential education in 6 colleges and schools of pharmacy in the Northwestern United States. METHODS: The 6 colleges and schools of pharmacy combined data on student placements needed, site availability, and changes made to placements during the 2009-2010 and 2010-2011 academic years and calculated capacity ratios for the advanced and introductory experience programs in the region. Comparisons also were made to previously published capacity results to determine whether the capacity ratio was useful in identifying trends and guiding preceptor and site development. RESULTS: Capacity ratio calculations were successful in facilitating comparison of capacity within and across regions. Experiential education is solvent in the Northwest overall, but specific parts of experiential programs were found to have more capacity than others. Trends in the Northwest were consistent with capacity in other regions. CONCLUSIONS: The capacity ratio can determine and facilitate comparison of solvency within and across colleges and schools of pharmacy and thereby inform decisions about resource management in experiential education.