Sample records for managing fluctuating staffing

  1. Applying management information systems to staffing.

    PubMed

    Hanson, R L

    1982-10-01

    A management information system (MIS) is a tool for managing resources effectively. After reviewing some concepts and principles for effective data management, Hanson clearly applies the concepts to nurse staffing systems, which manage human resources. He defines a seven-step process for establishing an MIS, from defining the management objective to implementing the system. Pointing out that an MIS need not be computerized to be effective, Hanson presents a positive perspective and clarifies some often-misconceived notions about management information systems and the paper printouts they generate. In the next issue of JONA, a second article by Hanson will take a more detailed look at the variety, use, and usefulness of staffing statistics available from an MIS for staffing. These articles are based on material in a forthcoming book, Management Systems for Nursing Service Staffing, to be published by Aspen Systems Corporation, Rockville, Maryland.

  2. The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

    PubMed

    Mobley, Lee R; Magnussen, Jon

    2002-01-01

    The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

  3. 77 FR 63872 - Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-17

    ... Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc...., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc., Select Staffing, and... follows: ''All workers of Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time...

  4. Reconciling Flexible Staffing Models with Inclusive Governance and Management

    ERIC Educational Resources Information Center

    Whitchurch, Celia; Gordon, George

    2013-01-01

    Higher education managers are under increasing pressure from governments to reduce costs by adopting more flexible staffing practices and tensions can arise as institutions seek to sustain motivation and morale across a diversifying workforce. This paper considers how institutional management and governance practices facilitate innovative…

  5. Effective workforce management starts with leveraging technology, while staffing optimization requires true collaboration.

    PubMed

    Crist-Grundman, Deborah; Mulrooney, Gail

    2011-01-01

    Effective staffing is at the very core of quality patient care. Staffing that achieves a balance between quality, safety, labor costs, and staff satisfaction is incredibly complex. Technology can make the complexity manageable and provide health care leaders with the tools to optimize their most valuable resource--their employees. Through such a partnership, the business intelligence brought forth will not only meet the unique needs and goals of each organization, but will also result in innovations and advancements in best practices around excellence in staffing.

  6. Staffing levels in endoscopy units.

    PubMed

    Ott, B J; Igo, M; Shields, N

    1994-04-01

    Staffing the endoscopy area has become increasingly complex. Growth in procedure volumes, changes in technology, and the application of endoscopy in the diagnosis and treatment of disease contribute to the complexities. The manager must deal with these changes, maintain costs, and still provide adequate staffing to ensure patient safety and quality care. The purpose of this article is to present the results of a laboratory manager survey conducted in 1990. Of 51 laboratory managers who responded, those who rated their laboratories to be adequately staffed averaged 4.2 hr per procedure. The survey results may be useful to laboratory managers seeking to calculate staff needs in a typical endoscopy area.

  7. Nursing home spending, staffing, and turnover.

    PubMed

    Kash, Bita A; Castle, Nicholas G; Phillips, Charles D

    2007-01-01

    Recent work on nursing home staffing and turnover has stressed the importance of ownership and resources. However, few studies have examined spending behaviors, which might also influence staffing levels and staff turnover rates. This study investigates whether spending behaviors measured by financial ratios are associated with staffing levels and staff turnover in nursing homes. We analyzed cross-sectional data from 1,014 Texas homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the 2003 Area Resource File. First, we examined differences in financial ratios by ownership type. Next, the effect of 10 financial ratios on staffing levels and turnover rates for registered nurses, licensed vocational nurses, and certified nursing assistants was examined using robust regression models. Descriptive data indicated that expense ratios related to resident care activities and staff development were significantly higher among not-for-profit than for-profit homes. Higher profits were associated with lower staffing levels, but not higher turnover rates. Administrative expenses (a measure of management capacity) had a negative impact both on staffing levels and staff turnover for licensed vocational nurses and certified nursing assistants, but they did not affect registered nurse staffing. Employee benefit expenses exhibited a positive impact on registered nurse and licensed vocational nurse staffing levels. The addition of information on financial ratios to models predicting staffing indicators reduced the effect of ownership on these indicators. Solutions to the staffing and turnover problem should focus on more effective management practices. Certain levels of administrative and staff benefit expenses may be necessary to improve professional staff recruitment and reduce both staffing and turnover costs. Differences in these financial ratios may partially explain the role played by ownership in determining staffing levels and turnover.

  8. Evaluation of nurse staffing levels and outcomes under the government--recommended staffing levels in Korea.

    PubMed

    Yu, Soyoung; Kim, Tae Gon

    2015-05-01

    This study aimed to evaluate registered nurse staffing levels and outcomes enforced by the current Korean nursing regulations. Registered nurse staffing levels are closely related to patient and nurse outcomes. Thus, the government's policy regarding nursing staffing has a practical impact, and better policies could lead to more appropriate nurse staffing. The actual evaluation of the government-recommended staffing levels in Korea is paramount for the establishment of a realistic and effective system that promotes quality care and patient safety. The participating hospital operated under the government-recommended staffing levels (Grade 2 of the Graded Fee of Nursing Management Inpatient System). For unit-level evaluations, one surgical unit was chosen and its staffing level was changed by assigning one additional registered nurse for 6 months. Length of hospitalisation, incidents of death, overtime hours and nursing job performance were measured prior to and after the addition of the extra staff. After 6 months, the length of patient hospitalisation and registered nurse overtime hours reduced and nurse job performance scores in the unit analysed improved. The results demonstrated that increasing the number of registered nurses beyond the current government-recommended staffing level improves patient and nurse outcomes. This indicates the importance and value of empirically assessing the need for changes in the recommended nurse staffing levels to develop appropriate, realistic and effective policies. © 2013 John Wiley & Sons Ltd.

  9. Managing the complexity of nurse shortages: a case study of bank and agency staffing in an acute care Trust in Wales, UK.

    PubMed

    Massey, Lynn; Esain, Ann; Wallis, Marianne

    2009-07-01

    Managing nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare. To analyse bank and agency nursing staffing patterns and factors that impact on these patterns. Case study within the largest hospital in one Welsh Integrated Healthcare Trust. De-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff. A predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training. There is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff.

  10. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria.

    PubMed

    Jooste, Karien; Prinsloo, Carine

    2013-03-13

    Staffing needs affect the nursing department's budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse) perceive the staffing of agency nurses in intensive care units (ICUs). The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n=124). One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  11. Determining Optimal Nursing Resources in Relation to Functions During the Oulu University Hospital Nurse Staffing Management Project.

    PubMed

    Liljamo, Pia; Lavander, Päivi; Kejonen, Pirjo

    2016-01-01

    The Oulu University Hospital's staffing management project sought information on the number of nursing staff in relation to treatment days and visits, using existing indicators to describe the activities involved. The retrospective data obtained was compared to human resources and the personnel structure. On this basis an optimal number of staff was determined for the units, taking account of a range of explanatory indicator data. The project made use of the computational model for nurse staffing and the World Health Organisation's (WHO) Workload Indicators of Staffing Need (WISN) method. The project provided extensive information on human resources issues within the units. Its results indicated the differences between wards with respect to the number and structure of resources. In addition, the nurse administrators lacked skills in gathering and using data from administrative datasets. This information will provide support for the further development of nursing operations and nursing management decision-making.

  12. Characterizing critical care physician staffing in rural America: a description of Iowa intensive care unit staffing.

    PubMed

    Mohr, Nicholas M; Collier, John; Hassebroek, Elizabeth; Groth, Heather

    2014-04-01

    This study aimed to characterize intensive care unit (ICU) physician staffing patterns in a predominantly rural state. A prospective telephone survey of ICU nurse managers in all Iowa hospitals with an ICU was conducted. Of 122 Iowa hospitals, 64 ICUs in 58 (48%) hospitals were identified, and 46 (72%) responded to the survey. Most ICUs (96%) used an open admission model and cared for undifferentiated medical and surgical patients (88%), and only 27% of open ICUs required critical care or pulmonary consultation for admitted patients. Most (59%) Iowa ICUs had a critical care physician or pulmonologist available, and high-intensity staffing was practiced in 30% of ICUs. Most physicians identified as practicing critical care (63%) were not board certified in critical care. Critical care physicians were available in a minority of hospitals routinely for inpatient intubation and cardiac arrest management (29% and 10%, respectively), and emergency physicians and other practitioners commonly responded to emergencies throughout the hospital. Many Iowa hospitals have ICUs, and staffing patterns in Iowa ICUs mirror closely national staffing practices. Most ICUs are multispecialty, open ICUs in community hospitals. These factors should inform training and resource allocation for intensivists in rural states. © 2014.

  13. Dynamic Staffing and Rescheduling in Software Project Management: A Hybrid Approach.

    PubMed

    Ge, Yujia; Xu, Bin

    2016-01-01

    Resource allocation could be influenced by various dynamic elements, such as the skills of engineers and the growth of skills, which requires managers to find an effective and efficient tool to support their staffing decision-making processes. Rescheduling happens commonly and frequently during the project execution. Control options have to be made when new resources are added or tasks are changed. In this paper we propose a software project staffing model considering dynamic elements of staff productivity with a Genetic Algorithm (GA) and Hill Climbing (HC) based optimizer. Since a newly generated reschedule dramatically different from the initial schedule could cause an obvious shifting cost increase, our rescheduling strategies consider both efficiency and stability. The results of real world case studies and extensive simulation experiments show that our proposed method is effective and could achieve comparable performance to other heuristic algorithms in most cases.

  14. Dynamic Staffing and Rescheduling in Software Project Management: A Hybrid Approach

    PubMed Central

    Ge, Yujia; Xu, Bin

    2016-01-01

    Resource allocation could be influenced by various dynamic elements, such as the skills of engineers and the growth of skills, which requires managers to find an effective and efficient tool to support their staffing decision-making processes. Rescheduling happens commonly and frequently during the project execution. Control options have to be made when new resources are added or tasks are changed. In this paper we propose a software project staffing model considering dynamic elements of staff productivity with a Genetic Algorithm (GA) and Hill Climbing (HC) based optimizer. Since a newly generated reschedule dramatically different from the initial schedule could cause an obvious shifting cost increase, our rescheduling strategies consider both efficiency and stability. The results of real world case studies and extensive simulation experiments show that our proposed method is effective and could achieve comparable performance to other heuristic algorithms in most cases. PMID:27285420

  15. Surviving the staffing crisis.

    PubMed

    Ehrhardt, Patty

    2002-01-01

    Numerous seminars and articles discuss the staffing shortage in health care and in the laboratory. Most of these have dealt with the importance of retaining and recruiting good employees. Given the median age of laboratories (49 years old), the decrease in medical technology schools, and a decline in people choosing the laboratory profession, the staffing shortage is here to stay and will affect the way we run our laboratories for years to come. Clinical systems managers need to identify and make the changes necessary in their laboratories to deal with the staffing shortage while maintaining quality testing and good customer service. This article will review the need and the process to assess laboratory operations along with the needs of the facility and/or health-care community. Obvious and not-so-obvious ideas for streamlining laboratory efficiencies along with maintaining high levels of quality and service will be presented.

  16. Comparison of Nurse Staffing Measurements in Staffing-Outcomes Research.

    PubMed

    Park, Shin Hye; Blegen, Mary A; Spetz, Joanne; Chapman, Susan A; De Groot, Holly A

    2015-01-01

    Investigators have used a variety of operational definitions of nursing hours of care in measuring nurse staffing for health services research. However, little is known about which approach is best for nurse staffing measurement. To examine whether various nursing hours measures yield different model estimations when predicting patient outcomes and to determine the best method to measure nurse staffing based on the model estimations. We analyzed data from the University HealthSystem Consortium for 2005. The sample comprised 208 hospital-quarter observations from 54 hospitals, representing information on 971 adult-care units and about 1 million inpatient discharges. We compared regression models using different combinations of staffing measures based on productive/nonproductive and direct-care/indirect-care hours. Akaike Information Criterion and Bayesian Information Criterion were used in the assessment of staffing measure performance. The models that included the staffing measure calculated from productive hours by direct-care providers were best, in general. However, the Akaike Information Criterion and Bayesian Information Criterion differences between models were small, indicating that distinguishing nonproductive and indirect-care hours from productive direct-care hours does not substantially affect the approximation of the relationship between nurse staffing and patient outcomes. This study is the first to explicitly evaluate various measures of nurse staffing. Productive hours by direct-care providers are the strongest measure related to patient outcomes and thus should be preferred in research on nurse staffing and patient outcomes.

  17. Prevention and management of "do not return" notices: a quality improvement process for supplemental staffing nursing agencies.

    PubMed

    Ade-Oshifogun, Jochebed Bosede; Dufelmeier, Thaddeus

    2012-01-01

    This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research. © 2012 Wiley Periodicals, Inc.

  18. The project shift: a form of participative management and staffing.

    PubMed

    Puckett, F

    1991-11-01

    North Colorado Medical Center is a 326 bed primary and tertiary care medical center serving northeastern Colorado and southwestern Nebraska. The pharmacy department provides 24-hour-a-day clinical and distributive services to both inpatients and outpatients with a staff of 1 clinical pharmacy coordinator, 10 pharmacists (excluding pharmacy manager), and 11 technicians. Rather than rely on one assistant manager, the pharmacy manager involves all interested staff pharmacists in various administrative, clinical, and distributive projects. These project (P) shifts are scheduled 8-hour shifts with minimal or no drug distribution duties. This staffing system and form of participative management has been used since 1983 and has been successful in achieving three objectives: it provides assistance to the manager in achieving certain departmental objectives; it provides job variety and professional growth/satisfaction for staff pharmacists; and it provides flexible and readily available source of pharmacists to meet personal leave days (vacation, illness, time off) needs.

  19. Nursing Home Staffing Standards: Their Relationship to Nurse Staffing Levels

    ERIC Educational Resources Information Center

    Mueller, Christine; Arling, Greg; Kane, Robert; Bershadsky, Julie; Holland, Diane; Joy, Annika

    2006-01-01

    Purpose: This study reviews staffing standards from the 50 states and the District of Columbia to determine if these standards are related to nursing home staffing levels. Design and Methods: Rules and regulations for states' nursing home staffing standards were obtained for the 50 states and the District of Columbia. Nurse staffing data were…

  20. Effective Staffing Takes a Village: Creating the Staffing Ecosystem.

    PubMed

    Gavigan, Margaret; Fitzpatrick, Therese A; Miserendino, Carole

    2016-01-01

    The traditional approaches to staffing and scheduling are often ineffective in assuring sufficient budgeting and deployment of staff to assure the right nurse at the right time for the right cost. As hospital merger activity increases, this exercise is further complicated by the need to rationalize staffing across multiple enterprises and standardize systems and processes. This Midwest hospital system successfully optimized staffing at the unit and enterprise levels by utilizing operations research methodologies. Savings were reinvested to improve staffing models which provided sufficient nonproductive coverage and patient-driven ratios. Over/under-staffing was eliminated in support of the system's recognition that adequate resource planning and deployment are critical to the culture of safety.

  1. Differentiated Staffing.

    ERIC Educational Resources Information Center

    Nassau County Board of Cooperative Educational Services, Westbury, NY.

    This is a compilation of articles examining many aspects of differentiated staffing and creating a basic document for all school districts. The articles are grouped into seven sections: 1) "Why Change?"; 2) "A Consideration of Staffing Problems"; 3) "Critics and Crusaders: An Analysis of Differentiated Staffing" (subsections on concept and…

  2. An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011.

    PubMed

    Burmen, B; Owuor, N; Mitei, P

    2017-01-26

    An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province). We set out to determine the optimum number of clinicians required to provide quality consultancy HIV care services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, JOOTRH, HIV Clinic, the premier HIV clinic in Nyanza province with a cumulative client enrolment of PLHIV of over 20,000 persons. The World Health's Organization's Workload Indicators of Staffing Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. Our assessment revealed a severe

  3. Making the transition to workload-based staffing: using the Workload Indicators of Staffing Need method in Uganda.

    PubMed

    Namaganda, Grace; Oketcho, Vincent; Maniple, Everd; Viadro, Claire

    2015-08-31

    Uganda's health workforce is characterized by shortages and inequitable distribution of qualified health workers. To ascertain staffing levels, Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The Workload Indicators of Staffing Need (WISN) method uses workload to determine number and type of staff required in a given facility. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources. A national WISN assessment (September 2012) used purposive sampling to select 136 public health facilities in 33/112 districts. The study examined staffing requirements for five cadres (nursing assistants, nurses, midwives, clinical officers, doctors) at health centres II (n = 59), III (n = 53) and IV (n = 13) and hospitals (n = 11). Using health management information system workload data (1 July 2010-30 June 2011), the study compared current and required staff, assessed workload pressure and evaluated the adequacy of the existing staffing norms. By the WISN method, all three types of health centres had fewer nurses (42-70%) and midwives (53-67%) than required and consequently exhibited high workload pressure (30-58%) for those cadres. Health centres IV and hospitals lacked doctors (39-42%) but were adequately staffed with clinical officers. All facilities displayed overstaffing of nursing assistants. For all cadres at health centres III and IV other than nursing assistants, the fixed norms or existing staffing or both fell short of the WISN staffing requirements, with, for example, only half as many nurses and midwives as required. The WISN results demonstrate the inadequacies of existing staffing norms, particularly for health centres III and IV. The results provide an evidence base to

  4. Workload and time management in central cancer registries: baseline data and implication for registry staffing.

    PubMed

    Chapman, Susan A; Mulvihill, Linda; Herrera, Carolina

    2012-01-01

    The Workload and Time Management Survey of Central Cancer Registries was conducted in 2011 to assess the amount of time spent on work activities usually performed by cancer registrars. A survey including 39 multi-item questions,together with a work activities data collection log, was sent by email to the central cancer registry (CCR) manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded to the survey.Results indicate that registries faced reductions in budgeted staffing from 2008-2009. The number of source records and total cases were important indicators of workload. Four core activities, including abstracting at the registry, visual editing,case consolidation, and resolving edit reports, accounted for about half of registry workload. We estimate an average of 12.4 full-time equivalents (FTEs) are required to perform all cancer registration activities tracked by the survey; however,estimates vary widely by registry size. These findings may be useful for registries as a benchmark for their own registry workload and time-management data and to develop staffing guidelines.

  5. Workload and Time Management in Central Cancer Registries: Baseline Data and Implication for Registry Staffing

    PubMed Central

    Chapman, Susan A.; Mulvihill, Linda; Herrera, Carolina

    2015-01-01

    The Workload and Time Management Survey of Central Cancer Registries was conducted in 2011 to assess the amount of time spent on work activities usually performed by cancer registrars. A survey including 39 multi-item questions, together with a work activities data collection log, was sent by email to the central cancer registry (CCR) manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded to the survey. Results indicate that registries faced reductions in budgeted staffing from 2008–2009. The number of source records and total cases were important indicators of workload. Four core activities, including abstracting at the registry, visual editing, case consolidation, and resolving edit reports, accounted for about half of registry workload. We estimate an average of 12.4 full-time equivalents (FTEs) are required to perform all cancer registration activities tracked by the survey; however, estimates vary widely by registry size. These findings may be useful for registries as a benchmark for their own registry workload and time-management data and to develop staffing guidelines. PMID:23493024

  6. Achieving effective staffing through a shared decision-making approach to open-shift management.

    PubMed

    Valentine, Nancy M; Nash, Jan; Hughes, Douglas; Douglas, Kathy

    2008-01-01

    Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders and executive management. Leading healthcare organizations are using open-shift management technology as a strategy to improve staffing effectiveness and the work environment. In many hospitals, open-shift management technology has become an essential workforce management tool, nursing benefit, and recruitment and retention incentive. In this article, the authors discuss how a successful nursing initiative to apply automation to open-shift scheduling and fulfillment across a 3-hospital system had a broad enterprise-wide impact resulting in dramatic improvements in nurse satisfaction, retention, recruitment, and the bottom line.

  7. The American Manager Overseas Representing Large U.S. Industrial Corporations; A Study of Selected Staffing Steps and Job Attitudes.

    ERIC Educational Resources Information Center

    Ivancevich, John Michael

    A study was made of overseas staffing procedures of large American industrial corporations, selection and predeparture training, and the job attitudes of overseas American managers. Questionnaire responses from 127 foreign operations managers (FOM) and 127 overseas managers were used. These were among the findings; (1) most overseas managers were…

  8. Medical management of motor fluctuations.

    PubMed

    Dewey, Richard B

    2008-08-01

    Given the magnitude of the problem of motor fluctuations in patients who have Parkinson's disease treated with levodopa, a significant effort has been expended by physicians, researchers, and pharmaceutical manufacturers over the years to find effective treatments. This article briefly reviews the medical options for managing motor fluctuations that are in common use in the United States or that are expected to be available soon.

  9. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special staffing payments. 9701.363 Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363 Special...

  10. Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

    PubMed

    Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

    2014-05-01

    Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more

  11. Improving Staffing and Nurse Engagement in a Neuroscience Intermediate Unit.

    PubMed

    Nadolski, Charles; Britt, Pheraby; Ramos, Leah C

    2017-06-01

    The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.

  12. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    PubMed

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  13. NURSE STAFFING AND RENAL ANAEMIA OUTCOMES IN HAEMODIALYSIS CARE.

    PubMed

    Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus

    2016-09-01

    Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  14. 77 FR 14832 - Plumchoice, Inc., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-13

    ...., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing, and Technisource..., 2012, applicable to workers of PlumChoice, Inc., including on-site leased workers from Balance Staffing... leased workers from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who...

  15. Forecasting staffing needs for productivity management in hospital laboratories.

    PubMed

    Pang, C Y; Swint, J M

    1985-12-01

    Daily and weekly prediction models are developed to help forecast hospital laboratory work load for the entire laboratory and individual sections of the laboratory. The models are tested using historical data obtained from hospital census and laboratory log books of a 90-bed southwestern hospital. The results indicate that the predictor variables account for 50%, 81%, 56%, and 82% of the daily work load variation for chemistry, hematology, and microbiology sections, and for the entire laboratory, respectively. Equivalent results for the weekly model are 53%, 72%, 12%, and 78% for the same respective sections. On the basis of the predicted work load, staffing assessment is made and a productivity monitoring system constructed. The purpose of such a system is to assist laboratory management in efforts to utilize laboratory manpower in a more efficient and cost-effective manner.

  16. Linking economics and quality: developing an evidence-based nurse staffing tool.

    PubMed

    Anderson, E Faye; Frith, Karen H; Caspers, Barbara

    2011-01-01

    The evidence linking nurse staffing with patient outcomes has been established; however, incorporating the evidence into practice is lagging. This article describes a practice/academic collaborative initiated to promote the translation of staffing research into decision-making through the development of an evidence-based staffing tool. Reports of previous research on nurse staffing and patient and financial outcomes are summarized, and aspects of the 2 phases of the collaborative to date are discussed. In the initial phase, a pilot research study on nurse staffing and patient outcomes in medical-surgical units support previous findings that higher nurse staffing results in positive patient outcomes. The focus in the current phase is expansion of the pilot research and the development of a decision-making staffing tool based on the additional staffing research. Identifying the critical data elements and sources of the data are major challenges to achieving the project objectives. Other challenges are maintaining interest and creating wide-spread understanding of the importance of nurse managers having access to timely, useable information. The success of the collaborative is due to the commitment and participation of leaders from various disciplines in both organizations.

  17. Organisational quality, nurse staffing and the quality of chronic disease management in primary care: observational study using routinely collected data.

    PubMed

    Griffiths, Peter; Maben, Jill; Murrells, Trevor

    2011-10-01

    An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient

  18. 75 FR 20384 - ABB, Inc., Including On-Site Leased Workers From Spherion Staffing, Dividend Staffing, Mystaff...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-19

    ...-Site Leased Workers From Spherion Staffing, Dividend Staffing, Mystaff, and Zero Chaos, Wichita Falls... from Spherion Staffing, Dividend Staffing, MyStaff, and Zero Chaos were employed on-site by the Wichita..., Dividend Staffing, MyStaff, and Zero Chaos working on-site at the Wichita Falls, Texas location of ABB, Inc...

  19. 10 CFR 719.15 - What are the requirements for a staffing and resource plan?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false What are the requirements for a staffing and resource plan... Management Plan § 719.15 What are the requirements for a staffing and resource plan? (a) For significant matters, the contractor must require retained legal counsel providing legal services to prepare a staffing...

  20. 10 CFR 719.15 - What are the requirements for a staffing and resource plan?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false What are the requirements for a staffing and resource plan... Management Plan § 719.15 What are the requirements for a staffing and resource plan? (a) For significant matters, the contractor must require retained legal counsel providing legal services to prepare a staffing...

  1. Staffing benchmarks for clinical laboratories: a College of American Pathologists Q-Probes study of laboratory staffing at 98 institutions.

    PubMed

    Jones, Bruce A; Darcy, Teresa; Souers, Rhona J; Meier, Frederick A

    2012-02-01

    Publicly available information concerning laboratory staffing benchmarks is scarce. One of the few publications on this topic summarized the findings of a Q-Probes study performed in 2004. This publication reports a similar survey with data collected in 2010. To assess the relationship between staffing levels in specified laboratory sections and test volumes in these sections and quantify management span of control. The study defined 4 laboratory sections: anatomic pathology (including cytology), chemistry/hematology/immunology, microbiology, and transfusion medicine. It divided staff into 3 categories: management, nonmanagement (operational or bench staff), and doctoral (MD, PhD) supervisory staff. People in these categories were tabulated as full-time equivalents and exclusions specified. Tests were counted in uniform formats, specified for each laboratory section, according to Medicare rules for the bundling and unbundling of tests. Ninety-eight participating institutions provided data that showed significant associations between test volumes and staffing for all 4 sections. There was wide variation in productivity based on volume. There was no relationship between testing volume per laboratory section and management span of control. Higher productivity in chemistry/hematology/immunology was associated with a higher fraction of tests coming from nonacute care patients. In both the 2004 and 2010 studies, productivity was inseparably linked to test volume. Higher test volume was associated with higher productivity ratios in chemistry/hematology/immunology and transfusion medicine sections. The impact of various testing services on productivity is section-specific.

  2. Nursing Management Minimum Data Set: Cost-Effective Tool To Demonstrate the Value of Nurse Staffing in the Big Data Science Era.

    PubMed

    Pruinelli, Lisiane; Delaney, Connie W; Garciannie, Amy; Caspers, Barbara; Westra, Bonnie L

    2016-01-01

    There is a growing body of evidence of the relationship of nurse staffing to patient, nurse, and financial outcomes. With the advent of big data science and developing big data analytics in nursing, data science with the reuse of big data is emerging as a timely and cost-effective approach to demonstrate nursing value. The Nursing Management Minimum Date Set (NMMDS) provides standard administrative data elements, definitions, and codes to measure the context where care is delivered and, consequently, the value of nursing. The integration of the NMMDS elements in the current health system provides evidence for nursing leaders to measure and manage decisions, leading to better patient, staffing, and financial outcomes. It also enables the reuse of data for clinical scholarship and research.

  3. A discrete event simulation tool to support and predict hospital and clinic staffing.

    PubMed

    DeRienzo, Christopher M; Shaw, Ryan J; Meanor, Phillip; Lada, Emily; Ferranti, Jeffrey; Tanaka, David

    2017-06-01

    We demonstrate how to develop a simulation tool to help healthcare managers and administrators predict and plan for staffing needs in a hospital neonatal intensive care unit using administrative data. We developed a discrete event simulation model of nursing staff needed in a neonatal intensive care unit and then validated the model against historical data. The process flow was translated into a discrete event simulation model. Results demonstrated that the model can be used to give a respectable estimate of annual admissions, transfers, and deaths based upon two different staffing levels. The discrete event simulation tool model can provide healthcare managers and administrators with (1) a valid method of modeling patient mix, patient acuity, staffing needs, and costs in the present state and (2) a forecast of how changes in a unit's staffing, referral patterns, or patient mix would affect a unit in a future state.

  4. Effects of State Minimum Staffing Standards on Nursing Home Staffing and Quality of Care

    PubMed Central

    Park, Jeongyoung; Stearns, Sally C

    2009-01-01

    Objective To investigate the impact of state minimum staffing standards on the level of staffing and quality of nursing home care. Data Sources Online Survey and Certification Reporting System (OSCAR) merged with the Area Resource File from 1998 through 2001. Study Design Between 1998 and 2001, 16 states implemented or expanded staffing standards in excess of federal requirements, creating a natural experiment in comparison with facilities in states without new standards. Difference-in-differences models using facility fixed effects were estimated to determine the effect of state standards. Data Collection/Extraction Methods OSCAR data were linked to the data on market conditions and state policies. A total of 55,248 facility-year observations from 15,217 freestanding facilities were analyzed. Principal Findings Increased standards resulted in small staffing increases for facilities with staffing initially below or close to new standards. Yet the standards were associated with reductions in restraint use and the number of total deficiencies at all types of facilities. Conclusions Mandated staffing standards affect only low-staff facilities facing potential for penalties, and effects are small. Selected facility-level outcomes may show improvement at all facilities due to a general response to increased standards or to other quality initiatives implemented at the same time as staffing standards. PMID:18823448

  5. Staffing the Global Organization: "Cultural Nomads"

    ERIC Educational Resources Information Center

    McPhail, Ruth; Fisher, Ron; Harvey, Michael; Moeller, Miriam

    2012-01-01

    This article explores the evolution of international staffing in an increasingly globalized and hypercompetitive marketplace. As the issue of staff retention becomes critical in global organizations, it is important to understand the types of managers that may be on or assigned to overseas assignments. The purpose of this article is to present a…

  6. The impact of HMO penetration on the relationship between nurse staffing and quality.

    PubMed

    Mark, Barbara A; Harless, David W; McCue, Michael

    2005-07-01

    While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.

  7. Creating pharmacy staffing-to-demand models: predictive tools used at two institutions.

    PubMed

    Krogh, Paul; Ernster, Jason; Knoer, Scott

    2012-09-15

    The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

  8. Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes.

    PubMed

    North, Nicola; Leung, William; Ashton, Toni; Rasmussen, Erling; Hughes, Frances; Finlayson, Mary

    2013-04-01

    To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers. © 2012 Blackwell Publishing Ltd.

  9. Nurse staffing and hospital ownership in California.

    PubMed

    Seago, Jean Ann; Spetz, Joanne; Mitchell, Shannon

    2004-05-01

    The purpose of this study is to describe the relationship between nurse staffing and owner type or specific corporate owner in California acute care hospitals. Little empirical data exist regarding nurse staffing as it relates to owner type or specific corporate owner. With minimum staffing ratios scheduled to be implemented in January 2004, this study provides baseline data for evaluating the impact of minimum staffing ratios in California. The study design is descriptive and cross-sectional. Data used in this study are for short-term general hospitals that reported to the California Office of Statewide Health Planning and Development database for fiscal years ending in 1997 through 1999. Six regression models were estimated using pooled data from the 3 years of data. The most consistent significant findings are: increased patient days or patient discharges predict increased registered nurse (RN) hours; lower RN wages predict increased RN hours; higher technology scores predict increased RN hours; and in 1998 there was an across-the-board decrease in RN hours. Other significant findings include that for-profit hospitals and for-profit systems had fewer RN productive hours for medical-surgical nursing, and select corporate owners, unrelated to profit status, had consistently fewer RN productive hours for medical-surgical nursing. For-profit hospitals and systems behaved differently in the healthcare market environment of the late 1990s. Select nonprofit systems were also using significantly less RN staffing. Other findings support the implication that as technology sophistication increases, there will be a need for increased RN hours to manage the advanced technology. This runs counter to the argument that increasing technology will decrease the need for RN hours. Finally, as discharges go up, the need for RN hours increases.

  10. A nurse staffing analysis at the largest hospital in the Gulf region

    NASA Astrophysics Data System (ADS)

    Louly, M.; Gharbi, A.; Azaiez, M. N.; Bouras, A.

    2014-12-01

    The paper considers a staffing problem at a local hospital. The managers consider they are understaffed and try to overwhelm the staffing deficit problem through overtime, rather than hiring additional nurses. However, the huge amount of allocated budget for overtime becomes a concern and needs some assessment, analysis and justification. The current hospital estimates suggests that the shortage at the hospital level corresponds to 300 full time equivalent (FTE) nurses, but the deficit is not basedon deep scientific approach. This paper deals with staffing model that provides the required scientific evidence on the deficit level. It also gives the accurate information on the overtime components. As a results, the suggested staffing model shows that some nursing units are unnecessarily overstaffed. Moreover, the current study reveals that the real deficit is of only 215 FTE resulting in a potential saving of 28%.

  11. A Panel Data Analysis of the Relationships of Nursing Home Staffing Levels and Standards to Regulatory Deficiencies

    PubMed Central

    Kovner, Christine; Harrington, Charlene; Greene, William; Mezey, Mathy

    2009-01-01

    Objective To examine the relationships between nursing staffing levels and nursing home deficiencies. Methods This panel data analysis employed random-effect models that adjusted for unobserved, nursing home–specific heterogeneity over time. Data were obtained from California's long-term care annual cost report data and the Automated Certification and Licensing Administrative Information and Management Systems data from 1999 to 2003, linked with other secondary data sources. Results Both total nursing staffing and registered nurse (RN) staffing levels were negatively related to total deficiencies, quality of care deficiencies, and serious deficiencies that may cause harm or jeopardy to nursing home residents. Nursing homes that met the state staffing standard received fewer total deficiencies and quality of care deficiencies than nursing homes that failed to meet the standard. Meeting the state staffing standard was not related to receiving serious deficiencies. Conclusions Total nursing staffing and RN staffing levels were predictors of nursing home quality. Further research is needed on the effectiveness of state minimum staffing standards. PMID:19181692

  12. A certain ratio? The policy implications of minimum staffing ratios in nursing.

    PubMed

    Buchan, James

    2005-10-01

    The debate about how best to determine nurse staffing levels continues. The conventional wisdom is that determining staffing levels is something best left to local management, taking account of local workload and resources. This 'bottom up' philosophy has now been challenged by the use of a different approach--the use of 'top down'standardized, and mandatory, nurse:patient or nurse:bed ratios. This paper examines the characteristics and early results of the use of staffing ratios in the two health systems where nurse staffing ratios are now mandatory--the states of Victoria (Australia) and California (USA). It then discusses the policy implications of using ratios. The paper identifies the main weaknesses of the use of nurse:patient ratios as being their relative inflexibility and their potential inefficiency, if they are wrongly calibrated. Their strength is their simplicity and their transparency. Their impact will be most pronounced when ratios are mandatory and where they offer a mechanism to improve and then to maintain staffing levels at some pre-determined level. The biggest challenges in their use are calibration (what is 'safe'? or 'minimum'?) and achieving the support of all stake-holders. The paper concludes that nurse:patient ratios are a blunt instrument for achieving employer compliance, where reliance on alternative, voluntary (and often more sophisticated) methods of determining nurse staffing have not been effective.

  13. Caregiver staffing in nursing homes and their influence on quality of care: using dynamic panel estimation methods.

    PubMed

    Castle, Nicholas G; Anderson, Ruth A

    2011-06-01

    There is inconclusive evidence that nursing home caregiver staffing characteristics influence quality of care. In this research, the relationship of caregiver staffing levels, turnover, agency use, and professional staff mix with quality is further examined using a longitudinal analysis to overcome weaknesses of earlier research. The data used came from a survey of nursing home administrators, Nursing Home Compare, the Online Survey Certification and Reporting data, and the Area Resource File. The staffing variables of Registered Nurses, Licensed Practical Nurses, and Nurse Aides were measured quarterly from 2003 through 2007, and came from 2839 facilities. Generalized method of moments estimation was used to examine the effects of changes in staffing characteristics on changes in 4 quality measures (physical restraint use, catheter use, pain management, and pressure sores). Regression analyses show a robust association between the staffing characteristic variables and quality indicators. A change to more favorable staffing is generally associated with a change to better quality. With longitudinal information and quarterly staffing information, we are able to show that for many nursing homes improving staffing characteristics will improve quality of care.

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

    PubMed

    Baggett, Margarita; Batcheller, Joyce; Blouin, Ann Scott; Behrens, Elizabeth; Bradley, Carol; Brown, Mary J; Brown, Diane Storer; Bolton, Linda Burnes; Borromeo, Annabelle R; Burtson, Paige; Caramanica, Laura; Caspers, Barbara A; Chow, Marilyn; Christopher, Mary Ann; Clarke, Sean P; Delucas, Christine; Dent, Robert L; Disser, Tony; Eliopoulos, Charlotte; Everett, Linda Q; Garcia, Amy; Glassman, Kimberly; Goodwin, Susan; Haagenson, Deb; Harper, Ellen; Harris, Kathy; Hoying, Cheryl L; Hughes-Rease, Marsha; Kelly, Lesly; Kiger, Anna J; Kobs-Abbott, Ann; Krueger, Janelle; Larson, Jackie; March, Connie; Martin, Deborah Maust; Mazyck, Donna; Meenan, Penny; McGaffigan, Patricia; Myers, Karen K; Nell, Kate; Newcomer, Britta; Cathy, Rick; O'Rourke, Maria; Rosa, Billy; Rose, Robert; Rudisill, Pamela; Sanford, Kathy; Simpson, Roy L; Snowden, Tami; Strickland, Bob; Strohecker, Sharon; Weems, Roger B; Welton, John; Weston, Marla; Valentine, Nancy M; Vento, Laura; Yendro, Susan

    2014-01-01

    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

  15. Nonmotor fluctuations: phenotypes, pathophysiology, management, and open issues.

    PubMed

    Classen, Joseph; Koschel, Jiri; Oehlwein, Christian; Seppi, Klaus; Urban, Peter; Winkler, Christian; Wüllner, Ullrich; Storch, Alexander

    2017-08-01

    Parkinson's disease (PD) is a neurodegenerative multisystem disorder characterized by progressive motor symptoms such as bradykinesia, tremor and muscle rigidity. Over the course of the disease, numerous non-motor symptoms, sometimes preceding the onset of motor symptoms, significantly impair patients' quality of life. The significance of non-motor symptoms may outweigh the burden through progressive motor incapacity, especially in later stages of the disease. The advanced stage of the disease is characterized by motor complications such as fluctuations and dyskinesias induced by the long-term application of levodopa therapy. In recent years, it became evident that various non-motor symptoms such as psychiatric symptoms, fatigue and pain also show fluctuations after chronic levodopa therapy (named non-motor fluctuations or NMFs). Although NMFs have moved into the focus of interest, current national guidelines on the treatment of PD may refer to non-motor symptoms and their management, but do not mention NMF, and do not contain recommendations on their management. The present article summarizes major issues related to NMF including clinical phenomenology and pathophysiology, and outlines a number of open issues and topics for future research.

  16. Comparison of nurse staffing based on changes in unit-level workload associated with patient churn.

    PubMed

    Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie

    2015-04-01

    This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.

  17. A grid to facilitate physics staffing justification.

    PubMed

    Klein, Eric E

    2009-12-03

    Justification of clinical physics staffing levels is difficult due to the lack of direction as how to equate clinical needs with the staffing levels and competency required. When a physicist negotiates staffing requests to administration, she/he often refers to American College of Radiology staffing level suggestions, and resources such as the Abt studies. This approach is often met with questions as to how to fairly derive the time it takes to perform tasks. The result is often insufficient and/or inexperienced staff handling complex and cumbersome tasks. We undertook development of a staffing justification grid to equate the clinical needs to the quantity and quality of staffing required. The first step is using the Abt study, customized to the clinical setting, to derive time per task multiplied by the anticipated number of such tasks. Inclusion of vacation, meeting, and developmental time may be incorporated along with allocated time for education and administration. This is followed by mapping the tasks to the level of competency/experience needed. For example, in an academic setting the faculty appointment levels correlate with experience. Non-staff personnel, such as IMRT QA technicians or clerical staff, should also be part of the equation. By using the staffing justification grid, we derived strong documentation to justify a substantial budget increase. The grid also proved useful when our clinical demands changed. Justification for physics staffing can be significantly strengthened with a properly developed data-based time and work analysis. A staffing grid is presented, along with a development methodology that facilitated our justification. Though our grid is for a large academic facility, the methodology can be extended to a non-academic setting, and to a smaller scale. This grid method not only equates the clinical needs with the quantity of staffing, but can also help generate the personnel budget, based on the type of staff and personnel required

  18. The impact of health information technology on staffing.

    PubMed

    Goldsack, Jennifer C; Robinson, Edmondo J

    2014-02-01

    Hospitals nationwide must demonstrate meaningful use by 2015 or face fines. For over 20 years, researchers have attempted to assess the impact of electronic record keeping technologies on the quality, safety, and efficiency of care, but results are inconclusive and hospital managers have little evidence on which to base staffing decisions as we hurtle toward the era of the paperless hospital.

  19. Team Approach to Staffing the Reference Center: A Speculation.

    ERIC Educational Resources Information Center

    Lawson, Mollie D.; And Others

    This document applies theories of participatory management to a proposal for a model that uses a team approach to staffing university library reference centers. In particular, the Ward Edwards Library at Central Missouri State University is examined in terms of the advantages and disadvantages of its current approach. Special attention is given to…

  20. Comparability of nurse staffing measures in examining the relationship between RN staffing and unit-acquired pressure ulcers: a unit-level descriptive, correlational study.

    PubMed

    Choi, JiSun; Staggs, Vincent S

    2014-10-01

    Various staffing measures have been used in examining the relationship between nurse staffing and patient outcomes. Little research has been conducted to compare these measures based on their explanatory power as predictors of nursing-sensitive outcomes. In this study, both administrative and nurse-reported measures were examined. Administrative measures included registered nurse (RN) skill mix and three versions of nursing hours per patient day (HPPD); nurse-reported measures included RN-reported number of assigned patients and RN-perceived staffing adequacy. To examine correlations among six nurse staffing measures and to compare their explanatory power in relation to unit-acquired pressure ulcers (UAPUs). Descriptive, correlational study. 2397 nursing units in 409 U.S. acute care hospitals. Random-intercept logistic regression analyses were performed using 2011 data from a national database. Relationships between nurse staffing measures and UAPU occurrences were examined in eight models, each with one or more staffing measures as predictors. Characteristics of nursing units (RN workgroup education level and RN workgroup unit tenure) and hospitals (size, teaching status, and Magnet status) were included as control variables. Two versions of HPPD (total nursing HPPD and RN HPPD) and RN skill mix were significantly correlated with RN-reported number of assigned patients (r range=-0.87 to -0.75). These staffing measures had weaker correlations with RN-perceived staffing adequacy (r range=0.16 to 0.23). Of the six staffing variables, only RN-perceived staffing adequacy and RN skill mix were significantly associated with UAPU odds, the former being the better predictor. Although RN-perceived staffing adequacy was not highly correlated with administrative measures of HPPD and RN skill mix, it was the strongest predictor of UAPU occurrences. RN-perceived staffing adequacy can serve as a more appropriate measure of staffing for nursing-sensitive outcomes research than

  1. Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

    PubMed

    McHugh, Matthew D; Berez, Julie; Small, Dylan S

    2013-10-01

    The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

  2. Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing

    PubMed Central

    McHugh, Matthew D.; Berez, Julie; Small, Dylan S.

    2015-01-01

    The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals’ financial incentives with payers’ and patients’ quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses’ efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients. PMID:24101063

  3. A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

    ERIC Educational Resources Information Center

    Kamis-Gould, Edna; And Others

    1991-01-01

    A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

  4. Staffing and Worker Injury in Nursing Homes

    PubMed Central

    Trinkoff, Alison M.; Johantgen, Meg; Muntaner, Carles; Le, Rong

    2005-01-01

    Objectives. We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states. Methods. We obtained First Reports of Injury and workers’ compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare’s Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics. Results. Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004). Conclusions. Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted. PMID:15983274

  5. Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

    PubMed

    Buerhaus, Peter I

    2009-01-01

    The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

  6. 42 CFR 491.8 - Staffing and staff responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Staffing and staff responsibilities. 491.8 Section...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.8 Staffing and staff responsibilities. (a) Staffing. (1) The clinic or center has a health care staff that includes one or more physicians...

  7. 42 CFR 491.8 - Staffing and staff responsibilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Staffing and staff responsibilities. 491.8 Section...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.8 Staffing and staff responsibilities. (a) Staffing. (1) The clinic or center has a health care staff that includes one or more physicians...

  8. 42 CFR 491.8 - Staffing and staff responsibilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Staffing and staff responsibilities. 491.8 Section...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.8 Staffing and staff responsibilities. (a) Staffing. (1) The clinic or center has a health care staff that includes one or more physicians...

  9. 42 CFR 491.8 - Staffing and staff responsibilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Staffing and staff responsibilities. 491.8 Section...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.8 Staffing and staff responsibilities. (a) Staffing. (1) The clinic or center has a health care staff that includes one or more physicians...

  10. 42 CFR 491.8 - Staffing and staff responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Staffing and staff responsibilities. 491.8 Section...: Conditions for Certification; and FQHCs Conditions for Coverage § 491.8 Staffing and staff responsibilities. (a) Staffing. (1) The clinic or center has a health care staff that includes one or more physicians...

  11. The Use of Flexible Staffing Arrangements in Core Production Jobs.

    ERIC Educational Resources Information Center

    Gramm, Cynthia L.; Schnell, John F.

    2001-01-01

    A 1994-96 survey of Alabama human resource managers indicated that unions deterred the use of flexible arrangements; subcontracting was positively related to core employees' wages; and flexible staffing was associated with core employee hiring costs and low-cost production strategies. Core employees gained job security through use of flexible…

  12. Finding the sweet spot: how to get the right staffing for variable workloads.

    PubMed

    Bryce, David J; Christensen, Taylor J

    2011-03-01

    All too often, hospital department managers set their staff schedules too much in anticipation of high levels of demand for services, leading to higher-than-necessary staffing costs when demand is lower than expected. The opposite approach of scheduling too few staff to meet demand, then relying on on-call or callback staff to address the shortage, also results in higher-than-necessary costs due to the premium wages that such staff must be paid. A staffing and workload simulation tool allows hospital departments to find the right balance between these extremes.

  13. Custodial Staffing Guidelines for Educational Facilities, Second Edition.

    ERIC Educational Resources Information Center

    APPA: Association of Higher Education Facilities Officers, Alexandria, VA.

    The 20 chapters of this guide to custodial staffing in educational facilities are grouped into five parts addressing: (1) staffing, (2) evaluation, (3) special considerations, (4) staff development tools, and (5) case studies. The five chapters on staffing are all by Jack C. Dudley and are titled: "General Methods"; "The Mathematics of Change";…

  14. Nurse staffing and NICU infection rates.

    PubMed

    Rogowski, Jeannette A; Staiger, Douglas; Patrick, Thelma; Horbar, Jeffrey; Kenny, Michael; Lake, Eileen T

    2013-05-01

    administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.

  15. 42 CFR 9.9 - Facility staffing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.9 Facility staffing. How many personnel are required to staff the chimpanzee sanctuary and what qualifications and training must the staff possess? (a... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate...

  16. 42 CFR 9.9 - Facility staffing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.9 Facility staffing. How many personnel are required to staff the chimpanzee sanctuary and what qualifications and training must the staff possess? (a... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate...

  17. 42 CFR 9.9 - Facility staffing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.9 Facility staffing. How many personnel are required to staff the chimpanzee sanctuary and what qualifications and training must the staff possess? (a... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate...

  18. 42 CFR 9.9 - Facility staffing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CHIMPANZEES HELD IN THE FEDERALLY SUPPORTED SANCTUARY SYSTEM § 9.9 Facility staffing. How many personnel are required to staff the chimpanzee sanctuary and what qualifications and training must the staff possess? (a... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate...

  19. 42 CFR 1007.13 - Staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Staffing requirements. 1007.13 Section 1007.13 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES STATE MEDICAID FRAUD CONTROL UNITS § 1007.13 Staffing requirements. (a) The unit will employ...

  20. Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes.

    PubMed

    Cummings, Greta G; Doupe, Malcolm; Ginsburg, Liane; McGregor, Margaret J; Norton, Peter G; Estabrooks, Carole A

    2017-06-01

    To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes. We used data from 40 care units in 12 Canadian nursing homes between 2007 and 2012. Descriptive statistics and tests of association and difference described relationships of two measures of staffing with resident and staff outcomes. Annualized rates of HCA WHRD from both data sources compared well at the facility level (Pearson Product Correlation; R = 0.847, p < .001), and were correlated similarly to staff work life and many QIs. Using ASSiST data, we show that staffing levels can vary by up to 40% at the unit-level within nursing homes. ASSiST is easy to collect, more timely to retrieve than administrative data, has good criterion and construct validity, and reflects intrafacility variation in health care aide staffing levels. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Staffing by Design: A Methodology for Staffing Reference

    ERIC Educational Resources Information Center

    Ward, David; Phetteplace, Eric

    2012-01-01

    The growth in number and kind of online reference services has resulted in both new users consulting library research services as well as new patterns of service use. Staffing in-person and virtual reference services desks adequately requires a systematic analysis of patterns of use across service points in order to successfully meet fluctuating…

  2. Comparative Costs and Staffing Report for Educational Facilities, 1997-1998.

    ERIC Educational Resources Information Center

    Glazner, Steve, Ed.

    This report presents comparative data on facility management costs and staffing based on responses from 193 U.S. postsecondary educational facilities and K-12 institutions during 1997-98. It also lists data from both private and public institutions. Section 1 contains general data on the survey response tally and institutional profiles listed by…

  3. 78 FR 8587 - Heraeus Kulzer, LLC., Including On-Site Leased Workers from People Link Staffing, Forge Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ...., Including On-Site Leased Workers from People Link Staffing, Forge Staffing, Career Transitions and Talent... Career Transitions and Talent Source were employed on-site at the South Bend, Indiana location of Heraeus... workers leased from Career Transitions and Talent Source working on-site at the South Bend, Indiana...

  4. Leadership, staffing and quality of care in nursing homes

    PubMed Central

    2011-01-01

    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

  5. Staffing and job satisfaction: nurses and nursing assistants.

    PubMed

    Kalisch, Beatrice; Lee, Kyung Hee

    2014-05-01

    The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses. This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units. Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction. Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff. Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career. © 2012 John Wiley & Sons Ltd.

  6. Allocation of resources for ambulatory care -a staffing model for outpatient clinics.

    PubMed Central

    Mansdorf, B D

    1975-01-01

    The enormous commitment of resources to ambulatory health care services requires that flexible and easily implementable management techniques be developed to improve the allocation of health manpower and funds. This article develops a feasible model for staffing outpatient clinics and thereby potentially provides an important analytical tool for allocating and monitoring the utilization of the most critical and expensive of ambulatory care resources-professional and nonprofessional clinic personnel. The model is simplistic, extremely flexible, and can be applied to many modes of delivering ambulatory care-from HMOs to traditional hospital outpatient clinics. To employ the model, certain decision variables must be specified so that the model can produce a least-cost staffing configuration to meet the demand for service in accordance with the desired mode and intensity of care. The key decision varables that require input from administrators and medical personnel include standards for physician-patient contact time, a desired ratio of staff time actually spent treating patients to total paid staff time, and the desired mix of various staff categories to achieve program objectives. Specific benefits of using the model include determining staffing for new, expanded, or existing outpatient clinics, determining budget requirements for such staffing needs, and providing quantitative productivity and utilization objectives and measurements. PMID:809787

  7. New law on staffing levels will save lives.

    PubMed

    2016-02-17

    Good news about nurse staffing levels can be hard to find, so how fantastic that a protracted campaign in Wales finally paid off last week with the passage of legislation to ensure hospital wards are staffed safely. Next month, the Queen will give royal assent to the Safe Nurse Staffing Levels (Wales) Bill, which will save lives, produce better outcomes and enhance the patient experience of care.

  8. Front-line management, staffing and nurse-doctor relationships as predictors of nurse and patient outcomes. a survey of Icelandic hospital nurses.

    PubMed

    Gunnarsdóttir, Sigrún; Clarke, Sean P; Rafferty, Anne Marie; Nutbeam, Don

    2009-07-01

    To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.

  9. Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients.

    PubMed

    Sunde, Geir Arne; Heltne, Jon-Kenneth; Lockey, David; Burns, Brian; Sandberg, Mårten; Fredriksen, Knut; Hufthammer, Karl Ove; Soti, Akos; Lyon, Richard; Jäntti, Helena; Kämäräinen, Antti; Reid, Bjørn Ole; Silfvast, Tom; Harm, Falko; Sollid, Stephen J M

    2015-08-07

    Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All

  10. Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.

    PubMed

    West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin

    2014-05-01

    To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

  11. Staffing and structure of infection prevention and control programs.

    PubMed

    Stone, Patricia W; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C; Furuya, E Yoko; Larson, Elaine

    2009-06-01

    The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P < .001). Median staffing was 1 IP per 167 beds. Forty-seven percent of IPs were certified, and 24 percent had less than 2 years of experience. Most directors or hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.

  12. Preparing for Staffings: 10 Tips for Parents and Educators

    ERIC Educational Resources Information Center

    Romaneck, Greg

    2005-01-01

    Staffings are designed to be problem-solving meetings. In theory, all participants come to a staffing with information, knowledge or general input aimed at designing an effective educational program for a child. However, in some cases, staffings become discordant sessions laced with conflict. In order to avoid this negative outcome, it may be…

  13. The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes

    PubMed Central

    Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.

    2016-01-01

    Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819

  14. Effect of staff turnover on staffing: A closer look at registered nurses, licensed vocational nurses, and certified nursing assistants.

    PubMed

    Kash, Bita A; Castle, Nicholas G; Naufal, George S; Hawes, Catherine

    2006-10-01

    We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the Area Resource File for 2003. After examining factors associated with staff turnover, we tested the significance and impact of staff turnover on staffing levels for registered nurses (RNs), licensed vocational nurses (LVNs) and certified nursing assistants (CNAs). All three staff types showed strong dependency on resources, such as reimbursement rates and facility payor mix. The ratio of contracted to employed nursing staff as well as RN turnover increased LVN turnover rates. CNA turnover was reduced by higher administrative expenditures and higher CNA wages. Turnover rates significantly reduced staffing levels for RNs and CNAs. LVN staffing levels were not affected by LVN turnover but were influenced by market factors such as availability of LVNs in the county and women in the labor force. Staffing levels are not always associated with staff turnover. We conclude that staff turnover is a predictor of RN and CNA staffing levels but that LVN staffing levels are associated with market factors rather than turnover. Therefore, it is important to focus on management initiatives that help reduce CNA and RN turnover and ultimately result in higher nurse staffing levels in nursing homes.

  15. Staffing Practices in the Private Sector in Sri Lanka

    ERIC Educational Resources Information Center

    Wickramasinghe, Vathsala

    2007-01-01

    Purpose: This paper seeks to present and discuss the findings of a study of staffing practices in the Sri Lankan private sector with particular reference to junior level managerial jobs. The scope of staffing practices consisted of six major areas, namely the usage of information from job analysis in staffing, the sources of labour, selection…

  16. The association of shift-level nurse staffing with adverse patient events.

    PubMed

    Patrician, Patricia A; Loan, Lori; McCarthy, Mary; Fridman, Moshe; Donaldson, Nancy; Bingham, Mona; Brosch, Laura R

    2011-02-01

    The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level. Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data. Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events. RN skill mix, total nursing care hours, and experience, measured by a proxy variable, were associated with shift-level adverse events. Consideration must be given to nurse staffing and experience levels on every shift.

  17. STAF: A Powerful and Sophisticated CAI System.

    ERIC Educational Resources Information Center

    Loach, Ken

    1982-01-01

    Describes the STAF (Science Teacher's Authoring Facility) computer-assisted instruction system developed at Leeds University (England), focusing on STAF language and major program features. Although programs for the system emphasize physical chemistry and organic spectroscopy, the system and language are general purpose and can be used in any…

  18. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

    PubMed

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

    2008-01-01

    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  19. Staffing and structure of infection prevention and control programs

    PubMed Central

    Stone, Patricia W.; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C.; Furuya, E. Yoko; Larson, Elaine

    2009-01-01

    Background The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Methods Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. Results The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P < .001). Median staffing was 1 IP per 167 beds. Forty-seven percent of IPs were certified, and 24 percent had less than 2 years of experience. Most directors or hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. Conclusion This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time. PMID:19201510

  20. Systematic review of the evidence related to mandated nurse staffing ratios in acute hospitals.

    PubMed

    Olley, Richard; Edwards, Ian; Avery, Mark; Cooper, Helen

    2018-04-17

    Objective The purpose of this systematic review was to evaluate and summarise available research on nurse staffing methods and relate these to outcomes under three overarching themes of: (1) management of clinical risk, quality and safety; (2) development of a new or innovative staffing methodology; and (3) equity of nursing workload. Methods The PRISMA method was used. Relevant articles were located by searching via the Griffith University Library electronic catalogue, including articles on PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline. Only English language publications published between 1 January 2010 and 30 April 2016 focusing on methodologies in acute hospital in-patient units were included in the present review. Results Two of the four staffing methods were found to have evidenced-based articles from empirical studies within the parameters set for inclusion. Of the four staffing methodologies searched, supply and demand returned 10 studies and staffing ratios returned 11. Conclusions There is a need to develop an evidence-based nurse-sensitive outcomes measure upon which staffing for safety, quality and workplace equity, as well as an instrument that reliability and validly projects nurse staffing requirements in a variety of clinical settings. Nurse-sensitive indicators reflect elements of patient care that are directly affected by nursing practice In addition, these measures must take into account patient satisfaction, workload and staffing, clinical risks and other measures of the quality and safety of care and nurses' work satisfaction. i. What is known about the topic? Nurse staffing is a controversial topic that has significant patient safety, quality of care, human resources and financial implications. In acute care services, nursing accounts for approximately 70% of salaries and wages paid by health services budgets, and evidence as to the efficacy and effectiveness of any staffing methodology is required

  1. Comparative Costs and Staffing Report for College and University Facilities, 1993-94.

    ERIC Educational Resources Information Center

    Silberman, Gil, Ed.; Glazner, Steve, Ed.

    This report presents comparative data on facility management costs and staffing based on responses from 516 U.S. postsecondary educational facilities during 1993-94. It lists statistics from both private and public institutions, beginning with statistical reductions presenting the survey response tally, institutional profiles, and mean costs per…

  2. Study of School District Administration and Staffing.

    ERIC Educational Resources Information Center

    Colorado State Dept. of Education, Denver.

    School district administration and staffing patterns are examined in this report prepared in response to CRS 22-2-118, which requires the Colorado Department of Education to conduct a study to determine where savings of state and local funds may be realized. Section 1 offers an analysis of district staffing patterns from existing data. The second…

  3. Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients.

    PubMed

    Cho, Eunhee; Park, Jeongyoung; Choi, Miyoung; Lee, Hye Sun; Kim, Eun-Young

    2018-03-01

    To examine the association of nurse staffing and education with the length of stay of surgical patients in acute care hospitals in South Korea. A cross-sectional survey design was used for a nurse survey in acute hospitals collected between 2008 and 2009. The survey data (N = 1,665) were linked with patient discharge data (N = 113,438) and hospital facility data from 58 hospitals with 100 or more beds in South Korea. The dependent variable was the length of stay, that is, the number of days a patient remained in the hospital. The independent variables were nurse staffing (number of patients per nurse) and nurses' education level (percentage of nurses with a bachelor of science in nursing [BSN] degree). A multilevel analysis was used to analyze the associations of nurse staffing and education level with the length of stay by controlling for both hospital and patient characteristics. The average proportion of nurses with a BSN in all the hospitals was 30.86%, while the average number of patients per nurse was 14.31. The median length of hospital stay for patients was about 7 days. The multilevel analysis showed that nurse staffing and nurse education level were significantly associated with the length of stay of surgical patients in acute care hospitals. A 10% increase in the average number of patients per nurse increased the length of stay by 0.284 days (p = .037). When the number of nurses with a BSN was increased by 1%, the length of stay decreased by 0.42 days (p = .025). Nurse staffing and nurses' education levels were significantly associated with the length of stay of surgical patients in South Korean hospitals. The findings from this study suggest that the South Korea healthcare system should develop appropriate strategies to improve the nurse staffing and education levels to ensure high-quality patient care in hospitals. Healthcare policymakers and nurse managers need to modify adequate nurse staffing and education levels in order to reduce the length of

  4. The effects of staffing and training on firm productivity and profit growth before, during, and after the Great Recession.

    PubMed

    Kim, Youngsang; Ployhart, Robert E

    2014-05-01

    This study integrates research from strategy, economics, and applied psychology to examine how organizations may leverage their human resources to enhance firm performance and competitive advantage. Staffing and training are key human resource management practices used to achieve firm performance through acquiring and developing human capital resources. However, little research has examined whether and why staffing and training influence firm-level financial performance (profit) growth under different environmental (economic) conditions. Using 359 firms with over 12 years of longitudinal firm-level profit data, we suggest that selective staffing and internal training directly and interactively influence firm profit growth through their effects on firm labor productivity, implying that staffing and training contribute to the generation of slack resources that help buffer and then recover from the effects of the Great Recession. Further, internal training that creates specific human capital resources is more beneficial for prerecession profitability, but staffing is more beneficial for postrecession recovery, apparently because staffing creates generic human capital resources that enable firm flexibility and adaptation. Thus, the theory and findings presented in this article have implications for the way staffing and training may be used strategically to weather economic uncertainty (recession effects). They also have important practical implications by demonstrating that firms that more effectively staff and train will outperform competitors throughout all pre- and postrecessionary periods, even after controlling for prior profitability. (c) 2014 APA, all rights reserved.

  5. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model.

    PubMed

    Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F

    2016-11-01

    percentile based on resident ADL care needs and compare the simulated staffing projections to the NH reported staffing levels. The percentage of scheduled care time that was omitted was estimated by the simulation model for each of the 65 workload scenarios using optimistic assumptions about staff productivity and efficiency. There was a low correlation between ADL workload and reported nurse aide staffing (Pearson = .11; P < .01), which suggests that most of the 13,500 NHs were not using ADL acuity to determine nurse aide staffing levels. Based on the DES model, the nurse aide staffing required for ADL care that would result in a rate of care omissions below 10% ranged from 2.8 hours/resident/day for NHs with a low workload (5th percentile) to 3.6 hours/resident/day for NHs with a high workload (95th percentile). In contrast, NHs reported staffing levels that ranged from an average of 2.3 to 2.5 hours/resident/day across all 5 workload percentiles. Higher workload NHs had the largest discrepancies between reported and predicted nurse aide staffing levels. The average nurse aide staffing levels reported by NHs falls below the level of staffing predicted as necessary to provide consistent ADL care to all residents in need. DES methodology can be used to determine nurse aide staffing requirements to provide ADL care and simulate management interventions to improve care efficiency and quality. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  6. Assessing nursing staffing ratios: variability in workload intensity.

    PubMed

    Upenieks, Valda V; Kotlerman, Jenny; Akhavan, Jaleh; Esser, Jennifer; Ngo, Myha J

    2007-02-01

    In 2004, California became the first state to implement specific nurse-to-patient ratios for all hospitals. These mandated enactments have caused significant controversy among health care professionals as well as nursing unions and professional organizations. Supporters of minimum nurse-to-patient ratios cite patient care quality, safety, and outcomes, whereas critics point to the lack of solid data and the use of a universally standardized acuity tool. Much more remains to be learned about staffing policies before mature links may be made regarding set staffing ratios and patient outcomes - specifically, how nurses spend their time in terms of variability in their daily work. This study examines two comparable telemetry units with a 1:3 staffing ratio within a California hospital system to determine the relative rates of variability in nursing activities. The results demonstrate significant differences in categorical nursing activities (e.g., direct care, indirect care, etc.) between the two telemetry units (chi(2) = 91.2028; p < or = .0001). No correlation was noted between workload categories with daily staffing ratios and staffing mix between the two units. Although patients were grouped in a similar telemetry classification category and care was mandated at a set ratio, patient needs were variable, creating a significant difference in registered nurse (RN) categorical activities on the two units.

  7. Nighttime intensivist staffing, mortality, and limits on life support: a retrospective cohort study.

    PubMed

    Kerlin, Meeta Prasad; Harhay, Michael O; Kahn, Jeremy M; Halpern, Scott D

    2015-04-01

    Evidence regarding nighttime physician staffing of ICUs is suboptimal. We aimed to determine how nighttime physician staffing models influence patient outcomes. We performed a multicenter retrospective cohort study in a multicenter registry of US ICUs. The exposure variable was the ICU's nighttime physician staffing model. The primary outcome was hospital mortality. Secondary outcomes included new limitations on life support, ICU length of stay, hospital length of stay, and duration of mechanical ventilation. Daytime physician staffing was studied as a potential effect modifier. The study included 270,742 patients in 143 ICUs. Compared with nighttime staffing with an attending intensivist, nighttime staffing without an attending intensivist was not associated with hospital mortality (OR, 1.03; 95% CI, 0.92-1.15; P = .65). This relationship was not modified by daytime physician staffing (interaction P = .19). When nighttime staffing was subcategorized, neither attending nonintensivist nor physician trainee staffing was associated with hospital mortality compared with attending intensivist staffing. However, nighttime staffing without any physician was associated with reduced odds of hospital mortality (OR, 0.79; 95% CI, 0.68-0.91; P = .002) and new limitations on life support (OR, 0.83; 95% CI, 0.75-0.93; P = .001). Nighttime staffing was not associated with ICU or hospital length of stay. Nighttime staffing with an attending nonintensivist was associated with a slightly longer duration of mechanical ventilation (hazard ratio, 1.05; 95% CI, 1.02-1.09; P < .001). We found little evidence that nighttime physician staffing models affect patient outcomes. ICUs without physicians at night may exhibit reduced hospital mortality that is possibly attributable to differences in end-of-life care practices.

  8. 22 CFR 62.72 - Staffing and support services.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Staffing and support services. 62.72 Section 62.72 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM Student and Exchange Visitor Information System (SEVIS) § 62.72 Staffing and support services. (a...

  9. Brown & Smith Communication Solutions: A Staffing System Simulation

    ERIC Educational Resources Information Center

    Small, Erika E.; Doll, Jessica L.; Bergman, Shawn M.; Heggestad, Eric D.

    2018-01-01

    Developing students' practical skills in strategic staffing and selection within the classroom can be challenging. This article describes a staffing system simulation designed to engage students and develop applied skills in strategic recruiting, assessment, and evaluation of job applicants. Instructors looking for a multifaceted team project…

  10. Westinghouse, DOE see apples, oranges in IG staffing report

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lobsenz, G.

    1994-03-01

    The operator of the Energy Department's Savannah River weapons plant has at least 1,800 more employees than it needs, and could save $400 million over a five-year period by cutting its staff accordingly, a DOE inspector general study says. Most of the boat - 1,206 employees - was attributed to excessive numbers of managers, with the inspector general concluding that Westinghouse Savannah River Co. had roughly twice as many layers of management than two other DOE weapons contractors. The study also concluded that Westinghouse in fiscal year 1992 significantly understated its actual staffing levels in reports to DOE, failing tomore » disclose 1,765 full-time employees or the equivalent hours worked. Through such underreporting Westinghouse was able to [open quotes]circumvent staffing ceilings established by the department,[close quotes] the study added. Overall, DOE Inspector General John Layton said Westinghouse's staff levels substantially exceeded those needed for efficient operation of the South Carolina nuclear weapons facility. Layton based his analysis on efficiency standards attained by other DOE weapons plant contractors, such as Martin Marietta Energy Systems at DOE's Oak Ridge, Tenn., plant and EG G Rocky Flats, as well as widely utilized worker performance requirements used by the Navy and private sector companies that perform work similar to that done at Savannah River.« less

  11. Nurse staffing patterns and hospital efficiency in the United States.

    PubMed

    Bloom, J R; Alexander, J A; Nuchols, B A

    1997-01-01

    The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.

  12. Enhancing Nursing Staffing Forecasting With Safety Stock Over Lead Time Modeling.

    PubMed

    McNair, Douglas S

    2015-01-01

    In balancing competing priorities, it is essential that nursing staffing provide enough nurses to safely and effectively care for the patients. Mathematical models to predict optimal "safety stocks" have been routine in supply chain management for many years but have up to now not been applied in nursing workforce management. There are various aspects that exhibit similarities between the 2 disciplines, such as an evolving demand forecast according to acuity and the fact that provisioning "stock" to meet demand in a future period has nonzero variable lead time. Under assumptions about the forecasts (eg, the demand process is well fit as an autoregressive process) and about the labor supply process (≥1 shifts' lead time), we show that safety stock over lead time for such systems is effectively equivalent to the corresponding well-studied problem for systems with stationary demand bounds and base stock policies. Hence, we can apply existing models from supply chain analytics to find the optimal safety levels of nurse staffing. We use a case study with real data to demonstrate that there are significant benefits from the inclusion of the forecast process when determining the optimal safety stocks.

  13. Managing Information Technology in Student Affairs: A Report on Policies, Practices, Staffing, and Technology.

    ERIC Educational Resources Information Center

    Barratt, Will

    This pilot study looks into how information technology practices are being conducted in student affairs. It compares common practices against which exemplary programs and best practices can be measured. After gathering information from five universities, a model was created that encompassed policy, staffing, technology, and practice as the best…

  14. Facilitating and Fostering Research across the University: Staffing Issues in Research Capacity Development

    ERIC Educational Resources Information Center

    Farquhar, Robin H.

    2005-01-01

    Presented at a 2005 Salzburg Seminar symposium on the management and support of university research, this paper examines a number of staffing issues concerning institutional capacity-building to foster research in higher education. Various categories of staff engaged in the research enterprise are identified and the diversity among them in terms…

  15. Staff Assist: A Resource to Improve Nursing Home Quality and Staffing

    ERIC Educational Resources Information Center

    Castle, Nicholas G.

    2011-01-01

    Purpose: This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Design and Methods: Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g.,…

  16. Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

    PubMed

    Park, Claire Su-Yeon

    2017-08-01

    To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

  17. Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study

    PubMed Central

    2012-01-01

    Background Studies over the past decades have shown an association between nurse staffing and patient outcomes, however, most of these studies were conducted in the West. Accordingly, the purpose of this study aimed to provide an overview of the research/evidence base which has clarified the relationship between nurse staffing and patient mortality of acute care hospital wards under a universal health insurance system and attempted to provide explanations for some of the phenomena that are unique in Taiwan. Methods Through stratified random sampling, a total of 108 wards selected from 32 hospitals in Taiwan were collected over a consecutive seven month period. The mixed effect logit model was used to explore the relationship between nurse staffing and patient mortality. Results The medians of direct-nursing-care-hour, and nurse manpower were 2.52 h, and 378 persons, respectively. The OR for death between the long direct-nursing-care-hour (> median) group and the short direct-nursing-care-hour (≦median) group was 0.393 (95% CI = [0.245, 0.617]). The OR for death between the high (> median) and the low (≦median) nurse manpower groups was 0.589 (95% CI = [0.381, 0.911]). Conclusions Findings from this study demonstrate an association of nurse staffing and patient mortality and are consistent with findings from similar studies. These findings have policy implications for strengthening the nursing profession, nurse staffing, and the hospital quality associated with nursing. Additional research is necessary to demonstrate adequate nurse staffing ratios of different wards in Taiwan. PMID:22348278

  18. Cost analysis of nursing home registered nurse staffing times.

    PubMed

    Dorr, David A; Horn, Susan D; Smout, Randall J

    2005-05-01

    To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

  19. Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

    PubMed

    Bowblis, John R; Roberts, Amy Restorick

    2018-06-01

    Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

  20. Predictors of obstetric intervention rates: case-mix, staffing levels and organisational factors of hospital of birth.

    PubMed

    Joyce, Rachel; Webb, R; Peacock, Janet

    2002-11-01

    We performed a cross-sectional study of all Thames maternity units, 1994-96, including 540,834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, which could be a reflection of less experienced management of labour. Caesarean section rates were also associated positively with the levels of delivery beds, which could be a reflection of the closer monitoring of labour that may result from increased bed availability. Both caesarean section and instrumental vaginal delivery rates were associated with epidural rates, which was expected from the literature. Variations in epidural rates were mainly associated with variations in demographic case-mix, due possibly to patient demand. Demographic case-mix was also associated with instrumental vaginal deliveries but not the caesarean section rate.

  1. Development, Validation, and Implementation of a Clinic Nurse Staffing Guideline.

    PubMed

    Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar

    2017-10-01

    Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.

  2. Estimating the staffing infrastructure for a patient-centered medical home.

    PubMed

    Patel, Mitesh S; Arron, Martin J; Sinsky, Thomas A; Green, Eric H; Baker, David W; Bowen, Judith L; Day, Susan

    2013-06-01

    The patient-centered medical home (PCMH) offers an innovative method of delivering primary care. However, the necessary staffing infrastructure is not well established. To evaluate the roles of personnel within a PCMH and to propose necessary staffing ratios and associated incremental costs to implement this model of care. We sampled primary care clinical practices that either have successfully deployed or were in the process of implementing a PCMH practice model. We conducted targeted interviews of administrators from these practices and reviewed published literature on the personnel roles within a PCMH. Collectively, these data were compared with current staffing standards and used to inform an analytical model and sensitivity analysis. Primary care practices that successfully transitioned to a PCMH have incorporated a range of new staff and functionalities. Based on our model, we estimated that 4.25 full-time equivalents (FTEs) should be allocated to staffing personnel per 1 physician FTE. Compared with the base-case model of current staffing in the United States of 2.68 FTEs per physician FTE, this is a 59% increase. After applying sensitivity analysis for variability in staffing and compensation, the incremental staffing FTE per physician FTE was 1.57 (range 1.41-1.73) and the incremental associated cost per member per month was $4.68 (range $3.79-$6.43). Our study suggests that additional staff with specific expertise and training is necessary to implement a PCMH. Further study and opportunities for funding additional staffing costs will be important for realizing the potential of the PCMH model of care.influence clinical recognition of depression among diabetes patients from different racial/ethnic groups, and the potential impact of low rates of clinical recognition on quality of care.

  3. Systematic review of studies of staffing and quality in nursing homes.

    PubMed

    Bostick, Jane E; Rantz, Marilyn J; Flesner, Marcia K; Riggs, C Jo

    2006-07-01

    To evaluate a range of staffing measures and data sources for long-term use in public reporting of staffing as a quality measure in nursing homes. Eighty-seven research articles and government documents published from 1975 to 2003 were reviewed and summarized. Relevant content was extracted and organized around 3 themes: staffing measures, quality measures, and risk adjustment variables. Data sources for staffing information were also identified. There is a proven association between higher total staffing levels (especially licensed staff) and improved quality of care. Studies also indicate a significant relationship between high turnover and poor resident outcomes. Functional ability, pressure ulcers, and weight loss are the most sensitive quality indicators linked to staffing. The best national data sources for staffing and quality include the Minimum Data Set (MDS) and On-line Survey and Certification Automated Records (OSCAR). However, the accuracy of this self-reported information requires further reliability and validity testing. A nationwide instrument needs to be developed to accurately measure staff turnover. Large-scale studies using payroll data to measure staff retention and its impact on resident outcomes are recommended. Future research should use the most nurse-sensitive quality indicators such as pressure ulcers, functional status, and weight loss.

  4. Managerial Ownership in Nursing Homes: Staffing, Quality, and Financial Performance.

    PubMed

    Huang, Sean Shenghsiu; Bowblis, John R

    2017-06-20

    Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. The predictable swarm: staying on top of radiology's cyclical staffing "bug".

    PubMed

    Ryan, Mary Jane

    2005-01-01

    Partners HealthCare System in Boston, MA, took some progressive and bold steps to address the recent staffing shortages in radiology. By addressing the shortage at the system level versus the individual hospital level, Partners was able to successfully recruit and support more than 80 new radiologic technologists from initial interest through graduation in 2 years. The recruitment effort helped reduce the utilization of temporary/agency personnel that cost the system more than dollar 6 million in 2001. The system utilized a multi-disciplinary team of professionals at many levels in the organization to achieve significant results in a relatively short period of time. Further, the organization channeled all available resources, including a grant from the US Department of Labor (DOL). The Boston Private Industry Council (BPIC), a local organization well known to the Partners HealthCare community benefits and human resources departments, managed the DOL grant. At least 64 of the first 80 graduates have accepted positions within Partners HealthCare radiology departments. The organization has further populated a database of more than 1,000 interested candidates, some of whom are currently in school and preparing for a future career in radiology, hopefully within the Partners HealthCare System. Partners HealthCare has managed to maintain a diversity rate at over 25% people of color by utilizing targeted recruiting efforts. Partners plans to continue to offer scholarships and other methods of support and career laddering for radiologic technologists in order to continue to meet staffing needs well in to the future. Partners HealthCare developed and implemented a "grow your own" strategy, and the system's leaders hold the philosophy that workforce development is a long-term investment requiring a flexible, permanent plan to stay ahead of the clinical staffing curve.

  6. Ontario: linking nursing outcomes, workload and staffing decisions in the workplace: the Dashboard Project.

    PubMed

    Fram, Nancy; Morgan, Beverley

    2012-03-01

    Research shows that nurses want to provide more input into assessing patient acuity, changes in patient needs and staffing requirements. The Dashboard Project involved the further development and application of an electronic monitoring tool that offers a single source of nursing, patient and organizational information. It is designed to help inform nurse staffing decisions within a hospital setting. The Dashboard access link was installed in computers in eight nursing units within the Hamilton Health Sciences (HHS) network. The Dashboard indicators are populated from existing information/patient databases within the Decision Support Department at HHS. Committees composed of the unit manager, staff nurses, project coordinator, financial controller and an information controller met regularly to review the Dashboard indicators. Participants discussed the ability of the indicators to reflect their patients' needs and the feasibility of using the indicators to inform their clinical staffing plans. Project findings suggest that the Dashboard is a work in progress. Many of the indicators that had originally been incorporated were refined and will continue to be revised based on suggestions from project participants and further testing across HHS. Participants suggested the need for additional data, such as the time that nurses are off the unit (for code blue response, patient transfers and accompanying patients for tests); internal transfers/bed moves to accommodate patient-specific issues and particularly to address infection control issues; deaths and specific unit-centred data in addition to the generic indicators. The collaborative nature of the project enabled staff nurses and management to work together on a matter of high importance to both, providing valuable recommendations for shared nursing and interprofessional planning, further Dashboard development and project management.

  7. The hospital based staffing agency.

    PubMed

    Manion, J; Reid, S B

    1989-01-01

    Before a hospital considers creating an internal staffing agency, a detailed business plan must be developed. By addressing marketing and operational issues in advance, nurse executives can avoid unnecessary business problems.

  8. Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes.

    PubMed

    Leary, Alison; Cook, Rob; Jones, Sarahjane; Smith, Judith; Gough, Malcolm; Maxwell, Elaine; Punshon, Geoffrey; Radford, Mark

    2016-12-16

    Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses. The data were obtained from 1 large acute National Health Service hospital trust in England. Routinely collected physiological, signs and symptom data from a clinical database were extracted, imported and mined alongside a bespoke staffing and outcomes database using Mathmatica V.10. The physiological data consisted of 120 million patient entries over 6 years, the bespoke database consisted of 9 years of daily data on staffing levels and safety factors such as falls. To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. After mining, 40 correlations (p<0.00005) emerged between safety factors, physiological data (such as the presence or absence of nausea) and staffing factors. Several inter-related factors demonstrated step changes where registered nurse availability appeared to relate to physiological parameters or outcomes such as falls and the management of symptoms. Data extraction proved challenging as some commercial databases were not built for extraction of the massive data sets they contain. The relationship between staffing and outcomes appears to exist. It appears to be non-linear but calculable and a data-driven model appears possible. These findings could be used to build an initial mathematical model for acute staffing which could be further tested. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  9. Wage, Work Environment, and Staffing: Effects on Nurse Outcomes

    PubMed Central

    McHugh, Matthew D.; Ma, Chenjuan

    2015-01-01

    Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes. PMID:25121923

  10. Wage, work environment, and staffing: effects on nurse outcomes.

    PubMed

    McHugh, Matthew D; Ma, Chenjuan

    2014-01-01

    Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes-less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. Minimum nurse staffing legislation and the financial performance of California hospitals.

    PubMed

    Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

    2012-06-01

    To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

  12. Establishing an NP-staffed minor emergency area.

    PubMed

    Buchanan, L; Powers, R D

    1997-04-01

    Patients with problems of high acuity need fully trained emergency physicians and nurses. Some patients with nonurgent problems can be cared for within the emergency department (ED) in a lower-cost setting designed and staffed specifically for this purpose. Staffing a fast track or minor emergency area (MEA) with nurse practitioners (NPs) is one way to satisfy the ED's care needs. One site analysis of the effectiveness of NPs indicates that patients are satisfied with their care, that nurses' interpersonal skills are better than those of physicians, that technical skills are equivalent, that patient outcomes are equivalent or superior and that NPs improve access to care. A nurse practitioner-staffed minor emergency area provides high quality care for approximately 21% of this site's adult emergency department population. Patients are triaged based on set criteria, allowing for short treatment times. The physical layout, triage criteria, and the NPs' scope of practice in the level 1 trauma center's ED are detailed.

  13. The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members.

    PubMed

    Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M

    2017-07-01

    Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

  14. Differentiated Staffing and Practice

    ERIC Educational Resources Information Center

    Christie, Kathy

    2005-01-01

    The development of the positions of nurse practitioner and physician assistant is a good example of differentiating staffing and practice to meet individual needs in an effective and cost-efficient way. This type of differentiation has been confined to the healthcare industry, principally to health maintenance organizations, but perhaps those in…

  15. Impact of Nurse Staffing Mandates on Safety-Net Hospitals: Lessons from California

    PubMed Central

    McHugh, Matthew D; Brooks Carthon, Margo; Sloane, Douglas M; Wu, Evan; Kelly, Lesly; Aiken, Linda H

    2012-01-01

    Context California is the first and only state to implement a patient-to-nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care—safety-net hospitals—remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safety-net hospitals following the mandate, while the skill mix remained essentially unchanged for safety-net hospitals. The difference between the two groups of hospitals was not significant. Conclusions California's mandate improved staffing for all hospitals, including safety-net hospitals

  16. Support sought for petition on safer staffing levels in Wales.

    PubMed

    2014-11-01

    RCN WALES is urging the public to sign an e-petition supporting draft legislation on safe staffing. The petition calls for support for the Safe Nursing Staffing Levels (Wales) Bill, drawn up by Welsh Liberal Democrat leader Kirsty Williams.

  17. Minimum Nurse Staffing Legislation and the Financial Performance of California Hospitals

    PubMed Central

    Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

    2012-01-01

    Objective To estimate the effect of minimum nurse staffing ratios on California acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. Study Design The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. PMID:22150627

  18. Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff.

    PubMed

    Bowblis, John R; Hyer, Kathryn

    2013-08-01

    To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

  19. The relationship of California's Medicaid reimbursement system to nurse staffing levels.

    PubMed

    Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

    2012-10-01

    Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

  20. Nursing Home Staffing Requirements and Input Substitution: Effects on Housekeeping, Food Service, and Activities Staff

    PubMed Central

    Bowblis, John R; Hyer, Kathryn

    2013-01-01

    Objective To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Data Sources Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Study Design Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. Data Extraction Method OSCAR surveys from 1999 to 2004. Principal Findings Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Conclusions Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. PMID:23445455

  1. Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

    PubMed

    Harrington, Charlene; Swan, James H; Carrillo, Helen

    2007-06-01

    To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates. Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources. Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix. RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors. To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.

  2. Hospital nurse wages and staffing, 1977 to 2002: cycles of shortage and surplus.

    PubMed

    Spetz, Joanne

    2004-09-01

    The author reviews the causes of nursing shortages and surpluses and examines data from California hospitals to demonstrate how these cycles are expressed in the demand for and wages of nurses. Nursing shortages have been reported cyclically for more than 50 years in the United States. There has been little data analysis demonstrating the relationship between the current shortage and changes in wages and nurse staffing. Analysis of longitudinal hospital and patient data from the California Office of Statewide Health Planning and Development. Summary statistics of patient utilization, nurse staffing, and nurse wages were computed. The data demonstrate that cyclical shortages are accompanied by higher wages and employment. This has been true in recent years. However, in medical-surgical units, hours per patient day declined between 2001 and 2002, perhaps reflecting the inability of hospitals to find more nurses to meet staffing goals. Nurse staffing per patient day and per discharge have remained stable, despite concerns about low staffing levels. Improved measures of patient care needs and studies of the precise staffing requirements for different types of patients and configurations of staff are required to make recommendations about staffing and policy.

  3. Demand management and case management: a conservation strategy.

    PubMed

    Bryant, C D R Anna K

    2007-01-01

    This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

  4. Intensivist physician staffing and the process of care in academic medical centres

    PubMed Central

    Kahn, Jeremy M; Brake, Helga; Steinberg, Kenneth P

    2007-01-01

    Background Although intensivist physician staffing is associated with improved outcomes in critical care, little is known about the mechanism leading to this observation. Objective To determine the relationship between intensivist staffing and select process‐based quality indicators in the intensive care unit. Research design Retrospective cohort study in 29 academic hospitals participating in the University HealthSystem Consortium Mechanically Ventilated Patient Bundle Benchmarking Project. Patients 861 adult patients receiving prolonged mechanical ventilation in an intensive care unit. Results Patient‐level information on physician staffing and process‐of‐care quality indicators were collected on day 4 of mechanical ventilation. By day 4, 668 patients received care under a high intensity staffing model (primary intensivist care or mandatory consult) and 193 patients received care under a low intensity staffing model (optional consultation or no intensivist). Among eligible patients, those receiving care under a high intensity staffing model were more likely to receive prophylaxis for deep vein thrombosis (risk ratio 1.08, 95% CI 1.00 to 1.17), stress ulcer prophylaxis (risk ratio 1.10, 95% CI 1.03 to 1.18), a spontaneous breathing trial (risk ratio 1.37, 95% CI 0.97 to 1.94), interruption of sedation (risk ratio 1.64, 95% CI 1.13 to 2.38) and intensive insulin treatment (risk ratio 1.40, 95% CI 1.18 to 1.79) on day 4 of mechanical ventilation. Models accounting for clustering by hospital produced similar estimates of the staffing effect, except for prophylaxis against thrombosis and stress ulcers. Conclusions High intensity physician staffing is associated with increased use of evidence‐based quality indictors in patients receiving mechanical ventilation. PMID:17913772

  5. Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

    PubMed

    Gabbay, Uri; Bukchin, Michael

    2009-01-01

    Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

  6. Picture perfect staffing in today's economy.

    PubMed

    Kolender, Ellen R

    2009-01-01

    This article describes the methods one Cancer Registry Department used to justify adequate staffing and obtain approval for an increase in full-time employees (FTEs). Each day it is getting more difficult to keep up with registry work while hospitals are compensating for loss of income by implementing changes that often impact staffing. Departments such as Cancer Registries, which are historically understaffed, must find ways to keep up with increasing workloads. If a hospital intends to maintain accreditation by the American College of Surgeons (ACoS) Commission on Cancer (CoC) and the treatment facility of choice for cancer patients, it is the opinion of this author that administrators must realize that adequate staff for the Cancer Registry Department is essential.

  7. Staffing effectiveness evaluation: a best kept secret for educational needs assessment.

    PubMed

    Hanna, Lee Ann

    2005-01-01

    Staff development educators use many sources of information to conduct educational needs assessments to improve existing educational programs and to develop new ones. Staffing effectiveness evaluation information targets patient care and staffing outcomes. The overall objective of this article is to familiarize staff development educators with the staffing effectiveness evaluation process, events that have led to organizational efforts to measure it, Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) expectations, methods for assessing variation and relationships of indicators, and implications for staff development educators.

  8. Staffing Subsidies and the Quality of Care in Nursing Homes

    PubMed Central

    Foster, Andrew D.; Lee, Yong Suk

    2015-01-01

    Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%. PMID:25814437

  9. Do Medicaid incentive payments boost quality? Florida's direct care staffing adjustment program.

    PubMed

    Hyer, Kathryn; Thomas, Kali S; Johnson, Christopher E; Harman, Jeffrey S; Weech-Maldonado, Robert

    2013-01-01

    Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents--the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.

  10. Determining medical staffing requirements for humanitarian assistance missions.

    PubMed

    Negus, Tracy L; Brown, Carrie J; Konoske, Paula

    2010-01-01

    The primary mission of hospital ships is to provide acute medical and surgical services to U.S. forces during military operations. Hospital ships also provide a hospital asset in support of disaster relief and humanitarian assistance (HA) operations. HA missions afford medical care to populations with vastly different sets of medical conditions from combat casualty care, which affects staffing requirements. Information from a variety of sources was reviewed to better understand hospital ship HA missions. Factors such as time on-site and location shape the mission and underlying goals. Patient encounter data from previous HA missions were used to determine expected patient conditions encountered in various HA operations. These data points were used to project the medical staffing required for future missions. Further data collection, along with goal setting, must be performed to accomplish successful future HA missions. Refining staffing requirements allows deployments to accomplish needed HA and effectively reach underserved areas.

  11. [Staffing in medical radiation physics in Germany--summary of a questionnaire].

    PubMed

    Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus

    2003-01-01

    To obtain an overview of the actual staffing levels in Medical Radiation Physics, a survey was carried out in 1999 by the task-group "Staffing requirements" of the Deutsche Gesellschaft für Medizinische Physik (DGMP; German Society of Medical Physics) among all DGMP members active in this field. The main components for equipment and activities are defined as in Report 8 and 10 of the DGMP for staffing requirements in Medical Radiation Physics. The survey focused on these main components. Of 322 forms sent out, 173 answers could be evaluated. From the answers regarding equipment and activities, theoretical staff requirements were calculated on the basis of this spot-check target and compared with the effective staffing levels documented in the survey. The spot-check data were then extrapolated to the whole Germany. The calculation revealed a deficit of 72% for the whole physics staff and of 58% for the number of physicists. Considering the age distribution of the DGMP members and the calculated staffing deficit, a training need was calculated of approximately 100 medical physicists per year in Germany, provided that the goal is set of cutting back the deficit in 10 years.

  12. Pediatric nurse staffing and quality of care in the hospital setting.

    PubMed

    Stratton, Karen M

    2008-01-01

    Indicators of quality and nurse staffing in pediatrics are distinct from adults. A retrospective, correlational, linear mixed model design was used to describe relationships between pediatric nurse staffing and 5 indicators of quality care from a convenience sample of 7 academic children's hospitals. Key findings supported a strong inverse relationship between the proportion of hours of pediatric nursing care delivered by registered nurses and the rate of occurrence of central line (P < .001) and bloodstream infections (P < .05). Supplemental nurse staffing hours also demonstrated relationships between bloodstream infections and parent/family complaints.

  13. [Structure of nurse labor market and determinants of hospital nurse staffing levels].

    PubMed

    Park, Bohyun; Seo, Sukyung; Lee, Taejin

    2013-02-01

    To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

  14. Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service.

    PubMed

    Oberholzer, Nicole; Kaserer, Alexander; Albrecht, Roland; Seifert, Burkhardt; Tissi, Mario; Spahn, Donat R; Maurer, Konrad; Stein, Philipp

    2017-07-01

    Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score < VI. Univariate and multivariable logistic regression analyses were performed to evaluate patient and mission characteristics of helicopter emergency service associated with insufficient pain management. A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). In the studied specific Swiss cohort, nontrauma patients

  15. Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing.

    PubMed

    van Oostveen, Catharina J; Mathijssen, Elke; Vermeulen, Hester

    2015-08-01

    To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing complexity of healthcare, hospital boards have been implementing NPRs and PCSs. However, many nurses at the unit level believe that staffing levels have become critically low, endangering the quality and safety of their patient care. This descriptive phenomenological qualitative study was conducted in a 1000-bed Dutch university hospital among 24 wards of four specialties (surgery, internal medicine, neurology, gynaecology & obstetrics and paediatric care). Data were collected from September until December 2012. To collect data four focus groups (n=44 nurses) were organized. Additionally, a total of 27 interviews (20 head nurses, 4 nurse directors and 3 quality advisors) were conducted using purposive sampling. The focus groups and interviews were audiotaped, transcribed and subjected to thematic analysis. Nurse staffing issues appear to be merely the 'tip of the iceberg'. Below the surface three underlying main themes became clear - nursing behaviour, authority, and autonomy - which are linked by one overall theme: nurses' position. In general, nurses' behaviour, way of thinking, decision-making and communication of thoughts or information differs from other healthcare disciplines, e.g. physicians and quality advisors. This results in a perceived and actual lack of authority and autonomy. This in turn hinders them to plead for adequate nurse staffing in order to achieve the common goal of safe and high-quality patient care. Nurses desired a valid nursing care intensity system as an interdisciplinary and objective communication tool that makes nursing care visible and creates possibilities for better positioning of nurses in hospitals and further professionalization in

  16. Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada

    PubMed Central

    Battista, Jerry J.; Patterson, Michael S.; Beaulieu, Luc; Sharpe, Michael B.; Schreiner, L. John; MacPherson, Miller S.; Van Dyk, Jacob

    2012-01-01

    The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively. PACS numbers: 87.55.N‐, 87.55.Qr PMID:22231223

  17. Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada.

    PubMed

    Battista, Jerry J; Clark, Brenda G; Patterson, Michael S; Beaulieu, Luc; Sharpe, Michael B; Schreiner, L John; MacPherson, Miller S; Van Dyk, Jacob

    2012-01-05

    The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center-specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per-case staffing ratios were also determined for larger-scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center-specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full-time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively.

  18. Effects of Medicare payment changes on nursing home staffing and deficiencies.

    PubMed

    Konetzka, R Tamara; Yi, Deokhee; Norton, Edward C; Kilpatrick, Kerry E

    2004-06-01

    To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. Online Survey, Certification and Reporting (OSCAR) data from 1996-2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.

  19. The Effect of Minimum Nurse Staffing Legislation on Uncompensated Care Provided by California Hospitals

    PubMed Central

    Harless, David W.; Pink, George H.; Spetz, Joanne; Mark, Barbara

    2010-01-01

    This study assesses whether California’s minimum nurse staffing legislation affected the amount of uncompensated care provided by California hospitals. Using data from California’s Office of Statewide Health Planning and Development, the American Hospital Association Annual Survey and InterStudy, we divide hospitals into quartiles based on pre-regulation staffing levels. Controlling for other factors, we estimate changes in the growth rate of uncompensated care in the three lowest staffing quartiles relative to the quartile of hospitals with the highest staffing level. Our sample includes short-term general hospitals over the period 1999 to 2006. We find that growth rates in uncompensated care are lower in the first three staffing quartiles as compared to the highest quartile; however, results are statistically significant only for county and for-profit hospitals in quartiles one and three. We conclude that minimum nurse staffing ratios may lead some hospitals to limit uncompensated care, likely due to increased financial pressure. PMID:21156707

  20. Twenty years of staffing, practice environment, and outcomes research in military nursing.

    PubMed

    Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S; Swiger, Pauline; Breckenridge-Sproat, Sara; Brosch, Laura Ruse; Jennings, Bonnie Mowinski

    Two decades ago, findings from an Institute of Medicine (IOM) report sparked the urgent need for evidence supporting relationships between nurse staffing and patient outcomes. This article provides an overview of nurse staffing, practice environment, and patient outcomes research, with an emphasis on findings from military studies. Lessons learned also are enumerated. This study is a review of the entire Military Nursing Outcomes Database (MilNOD) program of research. The MilNOD, in combination with evidence from other health care studies, provides nurses and leaders with information about the associations between staffing, patient outcomes, and the professional practice environment of nursing in the military. Leaders, therefore, have useful empirical evidence to make data-driven decisions. The MilNOD studies are the basis for the current Army nursing dashboard, and care delivery framework, called the Patent CaringTouch System. Future research is needed to identify ideal staffing based on workload demands, and provide leaders with factors to consider when operationalizing staffing recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Government chief nursing officers' perceptions of barriers to using research on staffing.

    PubMed

    Baernholdt, M; Lang, N M

    2007-03-01

    Current global healthcare problems include nursing shortages contributing to low nurse staffing. Low nurse staffing is associated with poor patient and nurse outcomes, but research utilization using these findings especially at the policy level remains slow. To assess high-ranking government nurses' perceptions of barriers to using research on nurse staffing. An electronic information message about the impact of nurse staffing was presented to government chief nursing officers (CNOs) from 110 countries. The CNOs' perceptions of local barriers to utilizing these research findings were then assessed in an electronic survey. The four factors that influence the first two stages of Rogers's five-stage model of diffusion were examined. The factors, characteristics of the adopter, organization, innovation and communication, were measured using an adapted version of the BARRIERS scale. Barriers were present in all four characteristics. The top barrier was lack of reports and studies in one place. Other barriers were lack of cooperation within the organization and lack of awareness of the research findings. Differences according to Gross National Income were also noted. The CNOs and other health policy advisors can use the findings in planning for adequate nurse staffing. Development of electronic newsletters with summaries of pertinent research for CNOs and other policy advisors is needed. Future studies on nurse staffing are warranted. They should focus on other settings and how best to share research findings with policymakers.

  2. Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation.

    PubMed

    Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E

    2016-08-01

    To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  3. Differentiated Staffing: Expectations and Pitfalls.

    ERIC Educational Resources Information Center

    Barbee, Don

    Once a differentiated staffing pattern has been adopted--with the understanding that it is not a panacea--staff members have an obligation to minimize distinctions of rank and prevent organizational rigidity by contributing in role areas other than their own and sharing in decisionmaking. Teacher aides are not expected to be substitutes for…

  4. What is the harm in imposing mandatory hospital nurse staffing regulations?

    PubMed

    Buerhaus, P I

    1997-01-01

    Efforts to establish mandated staffing ratios are shortsighted, and, though proponents may have the best intentions, many negative outcomes would flow from the public airing of this issue. The Institute of Medicine concluded in 1996 that there was insufficient quality outcome evidence to support the imposition of mandated nurse staffing ratios. The Massachusetts Nursing Association got legislation introduced in early 1996 which, if passed, would turn over to state lawmakers decisions governing nurse staffing in hospitals and other employment settings. There are high opportunity costs. Staffing regulations (if imposed) would force employers to ignore the dynamic interactions of economic, technology, capital, and labor supply variables, and thus needlessly impose the effect of increased labor costs on hospitals, taxpayers and nurses themselves. Chance for passage of this highly controversial legislation is unlikely, but the expenditure of political chips (and the loss of credibility) will increase the difficulty of obtaining a hearing from legislators the next time a nursing issue comes up.

  5. Staffing Patterns in Public School Systems: Current Status and Trends, Update 2001. Research Snapshot.

    ERIC Educational Resources Information Center

    Williams, Alicia D.; Protheroe, Nancy; Parks, Michael C.

    Staffing patterns in American public-school systems are presented in this report of the 2000-01 school year. The report addresses the following: why information about staffing ratios is important; how many people currently work in public schools; what proportion of these are teachers, administrators, and support staff; current staffing patterns in…

  6. Effects of Medicare Payment Changes on Nursing Home Staffing and Deficiencies

    PubMed Central

    Konetzka, R Tamara; Yi, Deokhee; Norton, Edward C; Kilpatrick, Kerry E

    2004-01-01

    Objective To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. Data Sources Online Survey, Certification and Reporting (OSCAR) data from 1996–2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. Study Design A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. Data Collection Methods The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. Principal Findings We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. Conclusions Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care. PMID:15149474

  7. What Factors Are Associated With Occupational Health Office Staffing, Job Stress, and Job Satisfaction?

    PubMed

    Moses, X J Ethan; Walters, Kevin M; Fisher, Gwenith G

    2016-06-01

    This study sought to identify factors associated with occupational health staffing in health care settings, provide benchmarking data, and investigate relationships between staffing and worker stress and satisfaction. Members of the Association of Occupational Health Professionals in Healthcare were sent an online survey. Data on facility served, staffing, job attitudes, and work stress were collected and analyzed. Number and types of personnel served were the largest predictors of staffing, accounting for 38 and 41% of the variability seen, respectively. Number of personnel served was related to worker stress and lack of work/life balance. Offices that required a provider presence had roughly one provider, seven nurses, and three clerical staff per 8000 personnel served. Occupational health workers are generally highly satisfied, and staffing has little relation to sources of job stress and satisfaction.

  8. Association of Nurse Engagement and Nurse Staffing on Patient Safety.

    PubMed

    Brooks Carthon, J Margo; Hatfield, Linda; Plover, Colin; Dierkes, Andrew; Davis, Lawrence; Hedgeland, Taylor; Sanders, Anne Marie; Visco, Frank; Holland, Sara; Ballinghoff, Jim; Del Guidice, Mary; Aiken, Linda H

    2018-06-08

    Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention. Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings. A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the association between nurse engagement, staffing, and nurse assessments of patient safety. Thirty-two percent of nurses gave their hospital a poor or failing patient safety grade. In 25% of hospitals, nurses fell in the least or only somewhat engaged categories. A 1-unit increase in engagement lowered the odds of an unfavorable safety grade by 29% (P < .001). Hospitals where nurses reported higher levels of engagement were 19% (P < .001) less likely to report that mistakes were held against them. Nurses in poorly staffed hospitals were 6% more likely to report that important information about patients "fell through the cracks" when transferring patients across units (P < .001). Interventions to improve nurse engagement and adequate staffing serve as strategies to improve patient safety.

  9. The labor market effects of California's minimum nurse staffing law.

    PubMed

    Munnich, Elizabeth L

    2014-08-01

    In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.

  10. The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations.

    PubMed

    Martínez-Fernández, Raul; Schmitt, Emmanuelle; Martinez-Martin, Pablo; Krack, Paul

    2016-08-01

    Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the "levodopa miracle." It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l-dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow-up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  11. 42 CFR 485.631 - Condition of participation: Staffing and staff responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Staffing and staff... participation: Staffing and staff responsibilities. (a) Standard: Staffing—(1) The CAH has a professional health care staff that includes one or more doctors of medicine or osteopathy, and may include one or more...

  12. 42 CFR 485.631 - Condition of participation: Staffing and staff responsibilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Staffing and staff... participation: Staffing and staff responsibilities. (a) Standard: Staffing—(1) The CAH has a professional health care staff that includes one or more doctors of medicine or osteopathy, and may include one or more...

  13. Outcomes of Physician-Staffed Versus Non-Physician-Staffed Helicopter Transport for ST-Elevation Myocardial Infarction.

    PubMed

    Gunnarsson, Sverrir I; Mitchell, Joseph; Busch, Mary S; Larson, Brenda; Gharacholou, S Michael; Li, Zhanhai; Raval, Amish N

    2017-02-02

    The effect of physician-staffed helicopter emergency medical service (HEMS) on ST-elevation myocardial infarction (STEMI) patient transfer is unknown. The purpose of this study was to evaluate the characteristics and outcomes of physician-staffed HEMS (Physician-HEMS) versus non-physician-staffed (Standard-HEMS) in patients with STEMI. We studied 398 STEMI patients transferred by either Physician-HEMS (n=327) or Standard-HEMS (n=71) for primary or rescue percutaneous coronary intervention at 2 hospitals between 2006 and 2014. Data were collected from electronic medical records and each institution's contribution to the National Cardiovascular Data Registry. Baseline characteristics were similar between groups. Median electrocardiogram-to-balloon time was longer for the Standard-HEMS group than for the Physician-HEMS group (118 vs 107 minutes; P=0.002). The Standard-HEMS group was more likely than the Physician-HEMS group to receive nitroglycerin (37% vs 15%; P<0.001) and opioid analgesics (42.3% vs 21.7%; P<0.001) during transport. In-hospital adverse outcomes, including cardiac arrest, cardiogenic shock, and serious arrhythmias, were more common in the Standard-HEMS group (25.4% vs 11.3%; P=0.002). After adjusting for age, sex, Killip class, and transport time, patients transferred by Standard-HEMS had increased risk of any serious in-hospital adverse event (odds ratio=2.91; 95% CI=1.39-6.06; P=0.004). In-hospital mortality was not statistically different between the 2 groups (9.9% in the Standard-HEMS group vs 4.9% in the Physician-HEMS group; P=0.104). Patients with STEMI transported by Standard-HEMS had longer transport times, higher rates of nitroglycerin and opioid administration, and higher rates of adjusted in-hospital events. Efforts to better understand optimal transport strategies in STEMI patients are needed. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  14. Hospital nurse staffing models and patient and staff-related outcomes.

    PubMed

    Butler, Michelle; Collins, Rita; Drennan, Jonathan; Halligan, Phil; O'Mathúna, Dónal P; Schultz, Timothy J; Sheridan, Ann; Vilis, Eileen

    2011-07-06

    Nurse staffing interventions have been introduced across countries in recent years in response to changing patient requirements, developments in patient care, and shortages of qualified nursing staff. These include changes in skill mix, grade mix or qualification mix, staffing levels, nursing shifts or nurses' work patterns. Nurse staffing has been closely linked to patient outcomes, organisational outcomes such as costs, and staff-related outcomes. Our aim was to explore the effect of hospital nurse staffing models on patient and staff-related outcomes. We searched the following databases from inception through to May 2009: Cochrane/EPOC resources (DARE, CENTRAL, the EPOC Specialised Register), PubMed, EMBASE, CINAHL Plus, CAB Health, Virginia Henderson International Nursing Library, the Joanna Briggs Institute database, the British Library, international theses databases, as well as generic search engines. Randomised control trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of interventions relating to hospital nurse staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective measure of patient or staff-related outcome. Seven reviewers working in pairs independently extracted data from each potentially relevant study and assessed risk of bias. We identified 6,202 studies that were potentially relevant to our review. Following detailed examination of each study, we included 15 studies in the review. Despite the number of studies conducted on this topic, the quality of evidence overall was very limited. We found no evidence that the addition of specialist nurses to nursing staff reduces patient death rates, attendance at the emergency department, or readmission rates, but it is likely to result in shorter patient hospital stays, and reductions in pressure ulcers. The evidence in relation to the impact of replacing Registered Nurses with unqualified

  15. The association between nurse staffing and omissions in nursing care: A systematic review.

    PubMed

    Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane

    2018-03-08

    To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  16. Nursing teamwork, staff characteristics, work schedules, and staffing.

    PubMed

    Kalisch, Beatrice J; Lee, Hyunhwa

    2009-01-01

    This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.

  17. Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey.

    PubMed

    Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M

    2016-09-01

    We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  18. The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets.

    PubMed

    Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

    2013-01-01

    Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets. In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.

  19. The relationship between nurse staffing and failure to rescue: where does it matter most?

    PubMed

    Talsma, AkkeNeel; Jones, Katherine; Guo, Ying; Wilson, Deleise; Campbell, Darrell A

    2014-09-01

    This study further expands on the relationship between nurse staffing levels and patient outcomes, in particular, failure to rescue. Many studies are based on single-site hospitals or single-year data, thus limiting the generalizations of the findings. The purpose was to evaluate in a multisite multiyear study the relationship between unit-level nurse staffing and FTR mortality, for ICU and non-ICU patients. Using administrative and actual unit level nurse staffing data, we used AHRQ 2003 Patient Safety Indicator (2003) software and matched those with the patient's discharge month. Fixed effects multilevel logistic analyses were used to take into account the hierarchical structure of the database and patient clustering within units. We controlled for patient demographics, clinical conditions, and CCS categories. The majority (94%) of cases were discharged from general care units, ICUs reported higher nurse staffing levels based on patient complexity. Expired cases were 3 years older, male, and nonwhite. For general care discharges, the relationship between RN level HPPD approached significance (P = 0.07), suggesting increased odds of higher FTR mortality with higher staffing levels. We did not observe any of the expected associations between the nurse staffing variables and FTR for either general care unit or ICU discharges. The comprehensive risk adjustments provided adequate "leveling of the playing field" to evaluate the impact of unit-based nurse staffing levels on FTR mortality. Future studies should evaluate the influence of unit environment and patient risk.

  20. The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: a questionnaire study.

    PubMed

    Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Kuusio, Hannamaria; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo

    2011-12-01

    Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. Cross-sectional questionnaire study. 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important. 2011 Elsevier Ltd. All rights reserved.

  1. Prepaid group practices offer lessons in staffing ratios.

    PubMed

    2004-05-01

    Capitated physician organizations and prepaid group practices share many similarities in staffing, care processes and infrastructure. Use these benchmarks to help conduct physician workforce planning.

  2. Maintenance Staffing Guidelines For Educational Facilities.

    ERIC Educational Resources Information Center

    APPA: Association of Higher Education Facilities Officers, Alexandria, VA.

    The purpose of this publication is to provide a resource or guide for educational facilities in establishing or developing a maintenance trades organization that is sufficient to accomplish basic facilities maintenance functions. The guidelines are intended to suggest staffing levels for those routine facilities maintenance activities that are…

  3. Community health centers employ diverse staffing patterns, which can provide productivity lessons for medical practices.

    PubMed

    Ku, Leighton; Frogner, Bianca K; Steinmetz, Erika; Pittman, Patricia

    2015-01-01

    Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served. Project HOPE—The People-to-People Health Foundation, Inc.

  4. 75 FR 22628 - Cadence Innovation, LLC, Groesbeck Plant, Including On-Site Leased Workers from Michigan Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-29

    ... Human Capital Staffing (TA-W-64,715C); Cadence Innovation, LLC, Hillsdale Plant, Hillsdale, Michigan... Innovation, LLC, Groesbeck Plant, Including On-Site Leased Workers from Michigan Staffing, LLC, Modern Professional Services, LLC, TAC Transportation, Time Services, Inc., and Human Capital Staffing Clinton...

  5. The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets

    PubMed Central

    Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert

    2013-01-01

    Background Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets Purpose In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. Methodology/Approach By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Findings Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Practice Implications Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost cutting measures may be inefficient and negatively affect financial performance. PMID:22543824

  6. Traffic signal operations and maintenance staffing guidelines.

    DOT National Transportation Integrated Search

    2009-03-01

    This report provides a guideline to estimate the staffing and resource needs required to effectively : operate and maintain traffic signal systems. The results of a survey performed under this project, as : well as a review of the literature and othe...

  7. Traffic signal operations and maintenance staffing guidelines

    DOT National Transportation Integrated Search

    2009-03-01

    This report provides a guideline to estimate the staffing and resource needs required to effectively operate and maintain traffic signal systems. The results of a survey performed under this project, as well as a review of the literature and other su...

  8. 29 CFR 1952.213 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 36 safety and 18 health compliance officers. After opportunity for public...

  9. 29 CFR 1952.233 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 23 safety and 14 health compliance officers. After opportunity for public...

  10. 29 CFR 1952.323 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 47 safety and 23 health compliance officers. After opportunity for public...

  11. 29 CFR 1952.93 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION..., in conjunction with OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 17 safety and 12 health compliance officers. After...

  12. 29 CFR 1952.223 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 22 safety and 14 health compliance officers. After opportunity for public...

  13. 29 CFR 1952.223 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 22 safety and 14 health compliance officers. After opportunity for public...

  14. 29 CFR 1952.343 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 6 safety and 2 health compliance officers. After opportunity for pulbic...

  15. 29 CFR 1952.353 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 9 safety and 6 health compliance officers. After opportunity for public...

  16. 29 CFR 1952.373 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 38 safety and 21 health compliance officers. After opportunity for public...

  17. 29 CFR 1952.203 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 31 safety and 12 health compliance officers. After opportunity for public...

  18. 29 CFR 1952.203 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 31 safety and 12 health compliance officers. After opportunity for public...

  19. 29 CFR 1952.343 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 6 safety and 2 health compliance officers. After opportunity for pulbic...

  20. 29 CFR 1952.373 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 38 safety and 21 health compliance officers. After opportunity for public...

  1. 29 CFR 1952.93 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION..., in conjunction with OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 17 safety and 12 health compliance officers. After...

  2. 29 CFR 1952.233 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 23 safety and 14 health compliance officers. After opportunity for public...

  3. 29 CFR 1952.323 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 47 safety and 23 health compliance officers. After opportunity for public...

  4. 29 CFR 1952.353 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 9 safety and 6 health compliance officers. After opportunity for public...

  5. 29 CFR 1952.213 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised compliance staffing benchmarks of 36 safety and 18 health compliance officers. After opportunity for public...

  6. Nurse Staffing and Quality of Care of Nursing Home Residents in Korea.

    PubMed

    Shin, Juh Hyun; Hyun, Ta Kyung

    2015-11-01

    To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea. We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately

  7. Worthy Work, Unlivable Wages: The National Child Care Staffing Study, 1988-1997.

    ERIC Educational Resources Information Center

    Whitebook, Marcy; Howes, Carollee; Phillips, Deborah

    In 1988, the National Child Care Staffing Study first gathered information on staffing and quality from a sample of child care centers in five metropolitan areas--Atlanta, Boston, Detroit, Phoenix, and Seattle--and returned for updated information in 1992. In 1997, directors of the original sample of centers still in operation were contacted again…

  8. The School Staffing Surge: Decades of Employment Growth in America's Public Schools

    ERIC Educational Resources Information Center

    Scafidi, Benjamin

    2012-01-01

    This report analyzes changes in public school staffing over time by examining data from the annual editions of the Digest of Education Statistics, which is compiled by the U.S. Department of Education's National Center for Education Statistics. The report's main part analyzes changes in public school staffing over the past generation, the fiscal…

  9. Flexible Staffing and Scheduling in U.S. Corporations. Research Bulletin No. 240.

    ERIC Educational Resources Information Center

    Christensen, Kathleen

    A national survey in 1988 probed the use of flexible staffing and scheduling alternatives in 521 of the largest U.S. corporations. Company executives indicated they expected their companies to decrease their rate of growth of contingent staffing and increase their use of flextime, job sharing, and home-based work. Several specifics stood out…

  10. Development of Staffing Patterns in Six New Medical Schools Established 1952-1960.

    ERIC Educational Resources Information Center

    National Institutes of Health (DHEW), Bethesda, MD. Resources Analysis Branch.

    This summary report of staffing patterns in 6 medical schools established between 1952 and 1960 is the first phase of a proposed study of biomedical staffing requirements in institutions of higher education, 1965-1975. The 6 schools are: the University of Miami, Albert Einstein College of medicine at Yeshiva University, the University of Florida,…

  11. Steady-State Staffing: A Second Report.

    ERIC Educational Resources Information Center

    Furniss, W. Todd

    This is a folow-up report on developments in long-range faculty personnel planning since the publication of "Steady-State Staffing in Tenure-Granting Institutions and Related Papers," covering the period from March through December 1973. Following references to newly available data, the paper deals first with work done at SUNY-Buffalo, Stanford,…

  12. Using Data to Assess Staffing and Services: University of Iowa Main Library

    ERIC Educational Resources Information Center

    Paulus, Amy R.

    2014-01-01

    The Main Library Service Desk is a one-stop academic help center located between a newly renovated student-focused space called the Learning Commons and the library collections. Services began with the first day of classes, August 26, 2013, and assessment has been ongoing, in part due to the availability of data. Staffing levels, staffing hours,…

  13. 29 CFR 1952.163 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 16 safety and 13 health compliance officers. After opportunity for public comment... established for each State operating an approved State plan. In September 1984, Iowa, in conjunction with OSHA...

  14. 29 CFR 1952.113 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 10 safety and 9 health compliance officers. After opportunity for public comments... established for each State operating an approved State plan. In September 1984, Utah, in conjunction with OSHA...

  15. 29 CFR 1952.113 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 10 safety and 9 health compliance officers. After opportunity for public comments... established for each State operating an approved State plan. In September 1984, Utah, in conjunction with OSHA...

  16. 29 CFR 1952.163 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 16 safety and 13 health compliance officers. After opportunity for public comment... established for each State operating an approved State plan. In September 1984, Iowa, in conjunction with OSHA...

  17. The clinical and economic impact of nurse to patient staffing ratios in women receiving intrapartum oxytocin.

    PubMed

    Clark, Steven L; Saade, George A; Meyers, Janet A; Frye, Donna R; Perlin, Jonathan B

    2014-02-01

    To examine the relationship between nurse-to-patient staffing ratios and perinatal outcomes in women receiving oxytocin during labor. A retrospective analysis of perinatal outcomes in women receiving oxytocin for induction or augmentation of labor during 2010. Outcomes examined were fetal distress, birth asphyxia, primary cesarean delivery, chorioamnionitis, endomyometritis, and a composite of adverse events. Frequency of 1:1 nurse-to-patient staffing was determined for each hospital. Outcomes were compared between hospitals categorized into quartiles of staffing ratios. In 208,033 women delivering during 2010, there was no relation between frequency of 1:1 nurse-to-patient staffing ratio and improved perinatal outcomes. Adoption of universal 1:1 staffing in the United States would result in the need for an additional 27,000 labor nurses and a cost of $1.6 billion. Available data do not support the imposition of mandatory 1:1 nurse-to-patient staffing ratios for women receiving oxytocin in all U.S. facilities. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  18. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand.

    PubMed

    Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H

    2011-12-01

    To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.

  19. The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes

    ERIC Educational Resources Information Center

    Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert

    2011-01-01

    Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…

  20. 29 CFR 1952.293 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 11 safety and 5 health compliance officers. After opportunity for public comment and... established for each State operating an approved State plan. In July 1986 Nevada, in conjunction with OSHA...

  1. 29 CFR 1952.293 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... staffing benchmarks of 11 safety and 5 health compliance officers. After opportunity for public comment and... established for each State operating an approved State plan. In July 1986 Nevada, in conjunction with OSHA...

  2. 29 CFR 1952.363 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... State operating an approved State plan. In May 1992, New Mexico completed, in conjunction with OSHA, a reassessment of the staffing levels initially established in 1980 and proposed revised benchmarks of 7 safety...

  3. 29 CFR 1952.363 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... State operating an approved State plan. In May 1992, New Mexico completed, in conjunction with OSHA, a reassessment of the staffing levels initially established in 1980 and proposed revised benchmarks of 7 safety...

  4. The effects of Medicaid reimbursement method and ownership on nursing home costs, case mix, and staffing.

    PubMed

    Cohen, J W; Dubay, L C

    1990-01-01

    In this study we analyze the effects of ownership and Medicaid cost containment initiatives on nursing home costs, payer mix, case mix, and staffing, using 1981 Medicare cost reports and Medicare/Medicaid Automated Certification files. As Medicaid cost containment incentives become stronger, nursing homes respond by decreasing case mix and commensurately decreasing staffing. When these incentives are especially strong, staffing is reduced beyond the apparently appropriate level, given the case mix. In addition, while chain facilities have lower costs than other types of facilities, these lower costs do not appear to come from either increased cream-skimming or reduced staffing levels.

  5. 75 FR 10318 - Venta-Airwasher, LLC, Including On-Site Leased Workers From Metro Staffing, Snelling and Office...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-05

    ..., Including On-Site Leased Workers From Metro Staffing, Snelling and Office Team Itasca, IL; Amended... from Metro Staffing, Snelling and Office Team were employed on-site at the Itasca, Illinois location of... amending this certification to include workers leased from Metro Staffing, Snelling and Office Team working...

  6. Ratios and nurse staffing: the vexed case of emergency departments.

    PubMed

    Wise, Sarah; Fry, Margaret; Duffield, Christine; Roche, Michael; Buchanan, John

    2015-02-01

    Within Australia nursing unions are pursuing mandated nurse-patient ratios to safeguard patient outcomes and protect their members in healthcare systems where demand perpetually exceeds supply. Establishing ratios for an emergency department is more contentious than for hospital wards. The study's aim was to estimate average staffing levels, skill mix and patient presentations in all New South Wales (NSW) Emergency Departments (EDs). The design was a retrospective historical census audit. Nurse rosters and patient presentation data were collected for three randomly selected census days in May 2010. Twenty-six valid responses out of 44 were returned. A ratio of the number of beds per nurse was calculated as well as skill mix and bed occupancy. The average beds per nurse ratios found were 3.8 (morning shift), 3.6 (evening), and 5.1 (night). However, ratios as high as 8.4 (morning), 7.3 (evening) and 16.0 (night) were identified on particular shifts. Overall a rich skill mix was found with an average of 90% of nursing hours being provided by Registered Nurses. The average daily bed occupancy of 4 patients per bed was similar across ED levels. The study adds to the limited literature on ED staffing and demonstrates the utility in the simplicity of ratios in flagging potential staffing problems. The audit revealed wide variation in staffing levels which was not always linked to patient activity. Of particular concern were the regional EDs (Level 5) which have the capacity to deal with all types of emergencies but where ratios as high as 7 beds per nurse were found during the day. Ratios cannot be used to determine the optimal staffing levels in every clinical situation; their purpose is to force an increase in nursing supply and to prevent individual units from becoming understaffed. Copyright © 2014 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Using a complex audit tool to measure workload, staffing and quality in district nursing.

    PubMed

    Kirby, Esther; Hurst, Keith

    2014-05-01

    This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.

  8. The Size and Scope of Collegiate Athletic Training Facilities and Staffing.

    PubMed

    Gallucci, Andrew R; Petersen, Jeffrey C

    2017-08-01

      Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified.   To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition.   Cross-sectional study.   Web-based survey.   Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs.   Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students.   The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft 2 (290.3 ± 411 m 2 ) for the central athletic training facility, 1013 ± 1521 ft 2 (94 ± 141 m 2 ) for satellite athletic training facilities, 1272 ± 1334 ft 2 (118 ± 124 m 2 ) for game-day athletic training facilities, 388 ± 575 ft 2 (36 ± 53 m 2 ) for athletic training offices, and 424 ± 884 ft 2 (39 ± 82 m 2 ) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P < .001). Differences among other levels of competition were not as well defined. Expansion or renovation of facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for

  9. Health Care Evolution Is Driving Staffing Industry Transformation.

    PubMed

    Faller, Marcia; Gogek, Jim

    2016-01-01

    The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.

  10. 32 CFR 651.6 - NEPA analysis staffing.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false NEPA analysis staffing. 651.6 Section 651.6 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY... depth of analysis required. In cases where the document addresses impacts to an environment whose...

  11. Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach.

    PubMed

    Taylor, Beth; Yankey, Nicholas; Robinson, Claire; Annis, Ann; Haddock, Kathleen S; Alt-White, Anna; Krein, Sarah L; Sales, Anne

    2015-01-01

    All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel. A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units. These projections were intended to develop appropriate budgets for each facility. While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility. This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital. Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.

  12. Nurses’ Perceptions of Critical Issues Requiring Consideration in the Development of Guidelines for Professional Registered Nurse Staffing for Perinatal Units

    PubMed Central

    Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine

    2012-01-01

    Objective To solicit input from registered nurse members of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Design Thematic analysis of responses to a cross-sectional on-line survey question: “Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units.” Participants N = 884 AWHONN members. Main Outcome Measure Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Results Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Conclusion Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. PMID:22690743

  13. Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions.

    PubMed

    Ms, Suzie Aparicio; Welch Bacon, Cailee E; Parsons, John T; Bay, R Curtis; Cohen, Randy P; DeZeeuw, Terry; McLeod, Tamara C Valovich

    2015-12-01

    The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Cross-sectional study. Web-based survey. Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured

  14. Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions

    PubMed Central

    MS, Suzie Aparicio; Welch Bacon, Cailee E.; Parsons, John T.; Bay, R. Curtis; Cohen, Randy P.; DeZeeuw, Terry; McLeod, Tamara C. Valovich

    2015-01-01

    Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their

  15. Guidelines for School Staffing Ratios. ERS Report.

    ERIC Educational Resources Information Center

    Stemnock, Suzanne K.

    Since early in this century educators have been proposing staffing formulas they believe will facilitate educational quality. The resulting guidelines represent a wide range of recommendations--from the possible to the utopian. School boards, teachers' groups, administrators, consultants, and taxpayers thus have a range of choices among the…

  16. Report on Staffing and Salaries, Fall 1990.

    ERIC Educational Resources Information Center

    Shymoniak, Leonard; And Others

    Tenth in a series of annual reports, this report presents fall 1990 demographic, staffing, salary, and workload information on California community college employees, based on data collected from all 71 California community college districts. Section I presents data on primary occupational activity, full-time equivalency, and type of assignment…

  17. Report on Staffing and Salaries, Fall 1993.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    Thirteenth in a series of annual reports, this document presents fall 1993 demographic, staffing, salary, and workload information on California community college employees, based on data collected from all 71 California community college districts. Section I presents data on primary occupational activity, full-time equivalency, and type of…

  18. Exploring the Micropolitics of Principal Staffing Advocacy

    ERIC Educational Resources Information Center

    Lochmiller, Chad R.

    2018-01-01

    Purpose: The purpose of this paper is to examine the micropolitical strategies principals use to influence school staffing within an urban school district. Design/methodology/approach: The author used a qualitative case study approach drawing upon 47 semi-structured participant interviews with 25 individual research participants, 80 hours of…

  19. The Impact of Staffing on Program Efficiency.

    ERIC Educational Resources Information Center

    Farmer, Ernest

    1988-01-01

    Adequate staffing for pupil transportation provides for the following: (1) drivers are appropriately instructed; (2) school buses meet the highest standards of construction and maintenance; (3) discipline is uniformly administered; (4) instruction in safe riding practices is provided; and (5) salary and fringe benefits retain the best qualified…

  20. Networks consolidation program: Maintenance and Operations (M&O) staffing estimates

    NASA Technical Reports Server (NTRS)

    Goodwin, J. P.

    1981-01-01

    The Mark IV-A consolidate deep space and high elliptical Earth orbiter (HEEO) missions tracking and implements centralized control and monitoring at the deep space communications complexes (DSCC). One of the objectives of the network design is to reduce maintenance and operations (M&O) costs. To determine if the system design meets this objective an M&O staffing model for Goldstone was developed which was used to estimate the staffing levels required to support the Mark IV-A configuration. The study was performed for the Goldstone complex and the program office translated these estimates for the overseas complexes to derive the network estimates.

  1. The RAFAELA system: a workforce planning tool for nurse staffing and human resource management.

    PubMed

    Fagerström, Lisbeth; Lønning, Kjersti; Andersen, Marit Helen

    2014-05-01

    The RAFAELA system was developed in Finland during the 1990s to help with the systematic and daily measurement of nursing intensity (NI) and allocation of nursing staff. The system has now been rolled out across almost all hospitals in Finland, and implementation has started elsewhere in Europe and Asia. This article describes the system, which aims to uphold staffing levels in accordance with patients' care needs, and its structure, which consists of three parts: the Oulu Patient Classification instrument; registration of available nursing resources; and the Professional Assessment of Optimal Nursing Care Intensity Level method, as an alternative to classical time studies. The article also highlights the benefits of using a systematic measurement of NI.

  2. The effects of RN staffing hours on nursing home quality: a two-stage model.

    PubMed

    Lee, Hyang Yuol; Blegen, Mary A; Harrington, Charlene

    2014-03-01

    Based on structure-process-outcome approach, this study examined the association of registered nurse (RN) staffing hours and five quality indicators, including two process measures (catheter use and antipsychotic drug use) and three outcome measures (pressure ulcers, urinary tract infections, and weight loss). We used data on resident assessments, RN staffing, organizational characteristics, and market factors to examine the quality of 195 nursing homes operating in a rural state of United States - Colorado. Two-stage least squares regression models were performed to address the endogenous relationships between RN staffing and the outcome-related quality indicators, and ordinary least squares regression was used for the process-related ones. This analysis focused on the relationship of RN staffing to nursing home quality indicators, controlling for organizational characteristics, resources, resident casemix, and market factors with clustering to control for geographical differences. Higher RN hours were associated with fewer pressure ulcers, but RN hours were not related to the other quality indicators. The study finding shows the importance of understanding the role of 'nurse staffing' under nursing home care, as well as the significance of associated/contextual factors with nursing home quality even in a small rural state. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Report on Staffing and Salaries, Fall 1989.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    This report presents fall 1989 demographic, staffing, salary, and workload information on California community college employees, based on data collected from 70 of the 71 districts in the state. First, tables present the total number of district employees by primary occupational activity; the number of full-time equivalent (FTE) employees by…

  4. High School Administrative Staffing in Washington State: Principal Perspectives on Resource Needs and Utilization

    ERIC Educational Resources Information Center

    Steach, John C.

    2011-01-01

    This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…

  5. 78 FR 8588 - Franklin Electric Company, Inc., Including On-Site Leased Workers From Peoplelink Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ..., Inc., Including On-Site Leased Workers From Peoplelink Staffing Solutions, Remedy Intelligent Staffing... the immediate certification. The Department has received information that workers from Remedy..., the Department is amending this certification to include workers leased from Remedy Intelligent...

  6. The relationship between nurses' stress and nurse staffing factors in a hospital setting.

    PubMed

    Purcell, Stacey R; Kutash, Mary; Cobb, Sarah

    2011-09-01

    The present study objective was to examine the relationships between nurses' stress and nurse staffing in a hospital setting. Nurses have many job-related stressors. There is a lack of research exploring the relationship between job stressors to staffing and day of week worked. The sample consisted of registered nurses (RNs) (N = 197) providing direct patient care. Data were collected via electronic software. Variables included demographic information, work setting information, Perceived Stress Scale (PSS) scores and Nursing Stress Scale (NSS) scores. Data analysis included descriptive statistics, correlations and analysis of variance. Among respondents, a positive correlation (r = 0.363, P  0.05) was found between the NSS and PSS and between age and patient work load (i.e. number of patients the nurse cared for) (r = 0.218, P < 0.05). A negative correlation (r = -0.142, P < 0.05) existed between NSS and respondents' age. Analysis of variance showed that younger nurses had more nursing stress than older nurses (F(1,195) = 4.283, P < 0.05). Age, patient work load and day of the week worked are important factors affecting nurses' stress levels. IMPLICATIONS FOR NURSING MANAGEMEN: Nurse managers should consider scheduling as a potential stressor for nurses. 2011 Blackwell Publishing Ltd.

  7. In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units.

    PubMed

    Parshuram, Christopher S; Kirpalani, Haresh; Mehta, Sangeeta; Granton, John; Cook, Deborah

    2006-06-01

    Physician staffing is an important determinant of patient outcomes following intensive care unit (ICU) admission. We conducted a national survey of in-house after-hours physician staffing in Canadian ICUs. : Cross-sectional survey. Canadian adult and pediatric ICUs. ICU directors. ICU directors of Canadian adult and pediatric ICUs were surveyed to describe overnight staffing by interns, residents, critical care medicine trainees, clinical assistants, and ICU physicians in their ICUs. Data were collected regarding hospital and ICU demographics and ICU staffing. For ICUs with in-house overnight physicians, we documented physician experience, shift duration, and clinical responsibilities outside the ICU. We identified 98 Canadian ICU directors, of whom 88 (90%) responded. Dedicated in-house physician coverage overnight was reported in 53 (60%) ICUs, including 13 (15%) in which ICU staff physicians stayed in-house overnight. Compared with ICUs without in-house physicians, those with in-house physicians had more ICU beds (15 vs. 8.5, p=.0001) and fewer ICU staff physicians (5 vs. 7, p=.03). For the 271 physicians who provide overnight staffing, the median level of postgraduate experience was 3 yrs (range, <1 yr, >10 yrs); 129 (48%) had <3 months of ICU experience. Most shifts (83%) were >20 hrs long. In-house overnight physician staffing in Canadian ICUs varies widely. Only a minority of ICUs comply with the 2003 Society of Critical Care Medicine guidelines for adult ICUs recommending continuous in-house staffing by ICU staff physicians. The duration of most ICU shifts raises concern about workload-associated fatigue and medical error. The impact of current nighttime staffing requires further evaluation with respect to patient outcomes.

  8. Determining minimum staffing levels during snowstorms using an integrated simulation, regression, and reliability model.

    PubMed

    Kunkel, Amber; McLay, Laura A

    2013-03-01

    Emergency medical services (EMS) provide life-saving care and hospital transport to patients with severe trauma or medical conditions. Severe weather events, such as snow events, may lead to adverse patient outcomes by increasing call volumes and service times. Adequate staffing levels during such weather events are critical for ensuring that patients receive timely care. To determine staffing levels that depend on weather, we propose a model that uses a discrete event simulation of a reliability model to identify minimum staffing levels that provide timely patient care, with regression used to provide the input parameters. The system is said to be reliable if there is a high degree of confidence that ambulances can immediately respond to a given proportion of patients (e.g., 99 %). Four weather scenarios capture varying levels of snow falling and snow on the ground. An innovative feature of our approach is that we evaluate the mitigating effects of different extrinsic response policies and intrinsic system adaptation. The models use data from Hanover County, Virginia to quantify how snow reduces EMS system reliability and necessitates increasing staffing levels. The model and its analysis can assist in EMS preparedness by providing a methodology to adjust staffing levels during weather events. A key observation is that when it is snowing, intrinsic system adaptation has similar effects on system reliability as one additional ambulance.

  9. Patient Care Staffing Levels and Facility Characteristics in U.S. Hemodialysis Facilities

    PubMed Central

    Yoder, Laura A. G.; Xin, Wenjun; Norris, Keith C.; Yan, Guofen

    2013-01-01

    Background Higher numbers of registered nurses per patient have been associated with improved patient outcomes in acute care facilities. Variation and associations of patient-care staffing levels and hemodialysis facility characteristics have not been previously examined. Study Design Cross-sectional study using Poisson regression to examine associations betwee patient-care staffing levels and hemodialysis facility characteristics. Setting & Participants 4,800 U.S. hemodialysis facilities in the 2009 CMS ESRD Annual Facility Survey (CMS-2744), USRDS. Predictors Facility characteristics, including profit status, freestanding status, chain affiliatio and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. Outcomes Patient care staffing levels, including ratios of Registered Nurses (RN), Licensed Practical Nurses (LPN), Patient Care Technicians (PCT), composite staff (RN+LPN+PCT), Social Workers, and Dietitians to in-center hemodialysis patients. Results After adjusting for background facility characteristics, the ratios of RNs and LPNs to patients were 35% (p<0.001) and 42% (p<0.001) lower, but the PCT-to-patient ratio was 16% (p<0.001) higher in for-profit facilities than those in nonprofit facilities (Rate ratio, 0.65, 95%CI, 0.63–0.68; 0.58, 0.51–0.65; 1.16, 1.12–1.19; respectively). Regionally, compared to the Northeast, the adjusted RN-to-patient ratio was 14% (p< 0.001) lower in the Midwest, 25% (p< 0.001) lower in the South, and 18% (p< 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN ratios than the largest nonprofit chain, but a significantly higher PCT-to-patient ratio. The overall composite staffing levels were also lower in for-profit and chain-affiliated facilities. The patterns hold when the hospital-based units were excluded. Limitations Nursing hours were not available. Conclusions The significant variation in patient-care staffing

  10. Infection prevention staffing and resources in U.S. acute care hospitals: Results from the APIC MegaSurvey.

    PubMed

    Pogorzelska-Maziarz, Monika; Gilmartin, Heather; Reese, Sara

    2018-06-01

    Given the changing nature of infection prevention and control (IPC), appropriate infection preventionist (IP) staffing needs to be established. In this study, we aimed to describe current IP staffing levels and IPC department resources in U.S. acute care hospitals. These data came from the 2015 MegaSurvey conducted by the Association of Professionals in Infection Prevention and Epidemiology. Descriptive statistics and bivariate analyses were conducted to examine differences in respondent, facility, and department characteristics by facility size (average inpatient census ≤100 vs >100). Data from 1623 respondents were included. Most (72%) had single-site responsibilities and dedicated 76%-100% of their job to IPC (68%). The overall median IP staffing was 1.25 IPs per 100 inpatient census (interquartile range = 1.81). Almost half (46%) represented facilities with daily inpatient census ≤100; the average number of IPs in these facilities was 1.1 (standard deviation = 0.7). The reported number of IPs increased steadily with higher patient census. Significant differences were observed in IP staffing, responsibilities, and support to the IPC department between smaller and larger hospitals. This study represents the current snapshot of IP staffing and IPC resources in acute care hospitals. Findings indicate important differences between large and small facilities in staffing and IPC resources. The field of infection prevention would benefit from a comprehensive assessment of IPC department staffing and resource needs. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  11. Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

    PubMed

    Dexter, Franklin; Abouleish, Amr E; Epstein, Richard H; Whitten, Charles W; Lubarsky, David A

    2003-10-01

    Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

  12. Staffing for Unmanned Aircraft Systems (UAS) Operations

    DTIC Science & Technology

    2016-06-01

    Service’s staffing determination . Using these business rules and observations enabled the follow-on assessment of individual UAS mission elements... Determination Framework ......................................................13  B.  Inherently Governmental (IG...authorities, and the determination of inherently governmental (IG) activities. Table 1. Delta between Rank/Pay Grades Annual Total Cost O-4 O-3 W-3 W-2

  13. 42 CFR 403.740 - Condition of participation: Staffing.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Condition of participation: Staffing. 403.740 Section 403.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

  14. 20 CFR 653.111 - State agency staffing requirements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... anticipated through expansion, contraction, and turnover in the office(s) and available funds, and all...

  15. 20 CFR 653.111 - State agency staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... anticipated through expansion, contraction, and turnover in the office(s) and available funds, and all...

  16. Managing manpower and cutting costs in the health care industry.

    PubMed

    Kocakülâh, Mehmet C; Wiggins, Laura M; Albin, Marvin

    2009-01-01

    The Bureau of Labor Statistics projects that health care services will account for one out of every six new jobs from 2002 to 2012. Based upon workload fluctuations, some companies in health care have opted to utilize "just-in-time" employees. Such an employee not only serves to stabilize the workforce but can also reduce employers' cost by allowing them to pay for labor only when they need it. Based on the analysis, a company should reduce reliance on casual staff, as the upfront cost per hire is far greater than hiring a temporary employee. Information presented points to fairly high turnover among casual employees, thus bolstering the argument against this staffing scheme when compared with temporary employee staffing.

  17. Queues and Reference Service: Some Implications for Staffing

    ERIC Educational Resources Information Center

    Regazzi, John J.; Hersberger, Rodney M.

    1978-01-01

    This study at an academic library used a simulation technique (1) to analyze the extent to which queues develop at a reference desk during peak periods, (2) to propose alternative staffing models to reduce queues, and (3) to examine the cost effectiveness of the alternatives. (Author/JAB)

  18. Medical staffing in Ontario neonatal intensive care units.

    PubMed

    Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D

    1989-06-01

    Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

  19. The effect of investor-owned chain acquisitions on hospital expenses and staffing.

    PubMed Central

    Manheim, L M; Shortell, S M; McFall, S

    1989-01-01

    Much concern has been raised about the effect of "corporatization" of health through the expansion of investor-owned hospital chains. One method of expansion is through hospital acquisition. At issue is the question of the effect of acquisitions on expenses and on such patient care inputs as staffing levels. In this article, we examine the effect of acquisition by one investor-owned chain on hospital costs and staffing. Subsequent to acquisition, hospital costs increase and staffing decreases, relative to competitor hospitals. However, since investor-owned hospitals not recently acquired do not have higher cost levels than their competitors, the increase in costs appears to be due to factors associated with the acquisition itself rather than factors associated with being an investor-owned hospital. Under the retrospective payment system in effect at the time, revenues also were higher for acquired hospitals. Under prospective payment, increasing revenues has been more difficult, decreasing acquisition incentives. PMID:2807933

  20. Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes.

    PubMed

    Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook

    2013-12-01

    The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

  1. Nurse staffing impact on quality of care in nursing homes: a systematic review of longitudinal studies.

    PubMed

    Backhaus, Ramona; Verbeek, Hilde; van Rossum, Erik; Capezuti, Elizabeth; Hamers, Jan P H

    2014-06-01

    The relationship between nurse staffing and quality of care (QoC) in nursing homes continues to receive major attention. The evidence supporting this relationship, however, is weak because most studies employ a cross-sectional design. This review summarizes the findings from recent longitudinal studies. In April 2013, the databases PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched. Studies were eligible if they (1) examined the relationship between nurse staffing and QoC outcomes, (2) included only nursing home data, (3) were original research articles describing quantitative, longitudinal studies, and (4) were written in English, Dutch, or German. The methodological quality of 20 studies was assessed using the Newcastle-Ottawa scale, excluding 2 low-quality articles for the analysis. No consistent relationship was found between nurse staffing and QoC. Higher staffing levels were associated with better as well as lower QoC indicators. For example, for restraint use both positive (ie, less restraint use) and negative outcomes (ie, more restraint use) were found. With regard to pressure ulcers, we found that more staff led to fewer pressure ulcers and, therefore, better results, no matter who (registered nurse, licensed practical nurse/ licensed vocational nurse, or nurse assistant) delivered care. No consistent evidence was found for a positive relationship between staffing and QoC. Although some positive indications were suggested, major methodological and theoretical weaknesses (eg, timing of data collection, assumed linear relationship between staffing and QoC) limit interpretation of results. Our findings demonstrate the necessity for well-designed longitudinal studies to gain a better insight into the relationship between nurse staffing and QoC in nursing homes. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  2. A Preliminary Analysis of a Strategic Staffing Initiative

    ERIC Educational Resources Information Center

    Pulliam, Cheryl L.; LaCaria, Lynne; Schoeneberger, Jason; Algozzine, Bob

    2014-01-01

    The authors evaluated a reform program known as "Strategic Staffing" in which principals were given increased autonomy to modify the delivery of instruction without compromising academic content. The program's central feature was reassignment of school leaders and key staff members from settings in which they were successful to schools…

  3. The impact of emergency department segmentation and nursing staffing increase on inpatient mortality and management times.

    PubMed

    Claret, Pierre-Géraud; Bobbia, Xavier; Olive, Sylvia; Demattei, Christophe; Yan, Justin; Cohendy, Robert; Landais, Paul; de la Coussaye, Jean Emmanuel

    2016-07-19

    The aim of our study was to investigate the impact of a new organization of our emergency department (ED) on patients' mortality and management delays. The ED segmentation consisted of the development of a new patient care geographical layout on a pre-existing site and changing the organization of patient flow. It took place on May 10, 2012. We did a before-after study in the ED of a university hospital, "before" (winter 2012) and "after" (summer 2012) reorganization by segmentation into sectors. All ED patients were included. Eighty-three thousand three hundred twenty-two patient visits were analyzed, 61,118 in phase "before", 22,204 during the phase "after". The overall inpatient mortality was 1.5 % during summer 2011 ("before" period), 1.8 % during winter 2012 ("before" period), 1.3 % during summer 2012 ("after" period) period (summer 2012 vs. winter 2012, OR = 0.72; 95 % CIs [0.61, 0.85], and summer 2012 vs. summer 2011, OR = 0.85; 95 % CIs [0.72, 0.99]). The mean (SD) time to first medical contact was 129 min (±133) during winter 2012 and 104 min (± 95) during summer 2012 (p < .05). Our study showed a decrease in mortality and improvement in time to first medical contact after the segmentation of our ED and nursing staffing increase, without an increase in medical personnel. Improving patient care through optimizing ED segmentation may be an effective strategy.

  4. Optimizing Staffing levels and Schedules for Railroad Dispatching Centers

    DOT National Transportation Integrated Search

    2004-09-01

    This report presents the results of a study to explore approaches to establishing staffing levels and schedules for railroad dispatchers. The : work was conducted as follow-up to a prior study that found fatigue among dispatchers, particularly those ...

  5. Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development.

    PubMed

    Griffiths, Peter; Ball, Jane; Drennan, Jonathan; Dall'Ora, Chiara; Jones, Jeremy; Maruotti, Antonello; Pope, Catherine; Recio Saucedo, Alejandra; Simon, Michael

    2016-11-01

    A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence, which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the National Institute for Health and Care Excellence guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing

  6. Nurse Staffing in Neonatal Intensive Care Units in the United States

    PubMed Central

    Rogowski, Jeannette A.; Staiger, Douglas O.; Patrick, Thelma E.; Horbar, Jeffrey D.; Kenny, Michael J.; Lake, Eileen T.

    2016-01-01

    The neonatal intensive care unit (NICU) is a setting with high nurse-to-patient ratios. Little is known about the factors that determine nurse workload and assignment. The goals of this study were to (1) develop a measure of NICU infant acuity; (2) describe the acuity distribution of NICU infants; (3) describe the nurse/infant ratio at each acuity level, and examine the factors other than acuity, including nurse qualifications and the availability of physicians and other providers, that determined staffing ratios; and (4) explore whether nurse qualifications were related to the acuity of assigned infants. In a two-stage cohort study, data were collected in 104 NICUs in 2008 by nurse survey (6,038 nurses and 15,191 infants assigned to them) and administrators reported on unit-level staffing of non-nurse providers; in a subset of 70 NICUs in 2009–2010, census data were collected on four selected shifts (3,871 nurses and 9,276 infants assigned to them). Most NICU infants (62%) were low-acuity (Levels 1 and 2); 12% of infants were high-acuity (Levels 4 and 5). The nurse-to-infant ratio ranged from 0.33 for the lowest-acuity infants to 0.95 for the highest-acuity infants. The staffing ratio was significantly related to the acuity of assigned infants but not to nurse education, experience, certification, or availability of other providers. There was a significant but small difference in the percentage of high-acuity (Levels 4 and 5) infants assigned to nurses with specialty certification (15% vs. 12% for nurses without certification). These staffing patterns may not optimize patient outcomes in this highly intensive pediatric care setting. PMID:26291315

  7. Primary Care-Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care.

    PubMed

    Levine, Debra S; McCarthy, John F; Cornwell, Brittany; Brockmann, Laurie; Pfeiffer, Paul N

    2017-05-01

    The study examined whether staffing of Primary Care-Mental Health Integration (PCMHI) services in the Department of Veterans Affairs (VA) health system is related to quality of depression care. Site surveys and administrative data from 349 VA facilities for fiscal year 2013 were used to calculate PCMHI staffing (full-time equivalents) per 10,000 primary care patients and discipline-specific staffing proportions for PCMHI psychologists, social workers, nurses, and psychiatric medication prescribers. Multivariable regression analyses were conducted at the facility level and assessed associations between PCMHI staffing ratios and the following indicators of depression treatment in the three months following a new episode of depression: any antidepressant receipt, adequacy of antidepressant receipt, any psychotherapy receipt, and psychotherapy engagement (three or more visits). Higher facility PCMHI staffing ratios were associated with a greater percentage of patients who received any psychotherapy treatment (B=1.16, p<.01) and who engaged in psychotherapy (B=.39, p<.01). When analyses controlled for total PCMHI staffing, the proportion of social workers as part of PCMHI was positively correlated with the percentage of patients with adequate antidepressant treatment continuation (B=3.16, p=.03). The proportion of nurses in PCMHI was negatively associated with the percentage of patients with engagement in psychotherapy (B=-2.83, p=.02). PCMHI programs with greater overall staffing ratios demonstrated better performance on indicators of psychotherapy for depression but not on indicators of antidepressant treatment. Further investigation is needed to determine whether differences in discipline-specific staffing play a causal role in driving associated differences in receipt of treatment.

  8. Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients?

    PubMed

    Horstmann, S; Rizos, T; Güntner, J; Hug, A; Jenetzky, E; Krumsdorf, U; Veltkamp, R

    2013-01-01

    Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population. Consecutive patients admitted to our stroke unit with acute ischaemic stroke were prospectively enrolled. The diagnostic work-up included neuroimaging, neuroultrasound, baseline 12-channel electrocardiogram (ECG), 24-h Holter ECG, continuous ECG monitoring, and echocardiography. Presence of AF was documented according to the medical history of each patient and after review of 12-lead ECG, 24-h Holter ECG, or continuous ECG monitoring performed during the stay on the ward. Additionally, a telephone follow-up visit was conducted for each patient after 3 months to inquire about newly diagnosed AF. Items for each patient-age, baseline NIHSS, left atrial dilatation, and stroke etiology according to the TOAST criteria - were assessed to calculate the STAF score. Overall, 584 patients were enrolled in our analysis. AF was documented in 183 (31.3%) patients. In multivariable analysis, age, NIHSS, left atrial dilatation, and absence of vascular etiology were independent predictors for AF. The logistic AF-prediction model of the STAF score revealed fair classification accuracy in receiver operating characteristic curve analysis with an area under the curve of 0.84. STAF scores of ≥5 had a sensitivity of 79% and a specificity of 74% for predicting AF. The value of the STAF score for predicting the risk of pAF in stroke patients is limited. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  9. Nurse staffing and patient outcomes in Belgian acute hospitals: cross-sectional analysis of administrative data.

    PubMed

    Van den Heede, Koen; Sermeus, Walter; Diya, Luwis; Clarke, Sean P; Lesaffre, Emmanuel; Vleugels, Arthur; Aiken, Linda H

    2009-07-01

    Studies have linked nurse staffing levels (number and skill mix) to several nurse-sensitive patient outcomes. However, evidence from European countries has been limited. This study examines the association between nurse staffing levels (i.e. acuity-adjusted Nursing Hours per Patient Day, the proportion of registered nurses with a Bachelor's degree) and 10 different patient outcomes potentially sensitive to nursing care. DESIGN-SETTING-PARTICIPANTS: Cross-sectional analyses of linked data from the Belgian Nursing Minimum Dataset (general acute care and intensive care nursing units: n=1403) and Belgian Hospital Discharge Dataset (general, orthopedic and vascular surgery patients: n=260,923) of the year 2003 from all acute hospitals (n=115). Logistic regression analyses, estimated by using a Generalized Estimation Equation Model, were used to study the association between nurse staffing and patient outcomes. The mean acuity-adjusted Nursing Hours per Patient Day in Belgian hospitals was 2.62 (S.D.=0.29). The variability in patient outcome rates between hospitals is considerable. The inter-quartile ranges for the 10 patient outcomes go from 0.35 for Deep Venous Thrombosis to 3.77 for failure-to-rescue. No significant association was found between the acuity-adjusted Nursing Hours per Patient Day, proportion of registered nurses with a Bachelor's degree and the selected patient outcomes. The absence of associations between hospital-level nurse staffing measures and patient outcomes should not be inferred as implying that nurse staffing does not have an impact on patient outcomes in Belgian hospitals. To better understand the dynamics of the nurse staffing and patient outcomes relationship in acute hospitals, further analyses (i.e. nursing unit level analyses) of these and other outcomes are recommended, in addition to inclusion of other study variables, including data about nursing practice environments in hospitals.

  10. Multidisciplinary Critical Care and Intensivist Staffing: Results of a Statewide Survey and Association With Mortality.

    PubMed

    Yoo, Erika J; Edwards, Jeffrey D; Dean, Mitzi L; Dudley, R Adams

    2016-06-01

    The role of multidisciplinary teams in improving the care of intensive care unit (ICU) patients is not well defined, and it is unknown whether the use of such teams helps to explain prior research suggesting improved mortality with intensivist staffing. We sought to investigate the association between multidisciplinary team care and survival of medical and surgical patients in nonspecialty ICUs. We conducted a community-based, retrospective cohort study of data from 60 330 patients in 181 hospitals participating in a statewide public reporting initiative, the California Hospital Assessment and Reporting Taskforce (CHART). Patient-level data were linked with ICU organizational data collected from a survey of CHART hospital ICUs between December 2010 and June 2011. Clustered logistic regression was used to evaluate the independent effect of multidisciplinary care on the in-hospital mortality of medical and surgical ICU patients. Interactions between multidisciplinary care and intensity of physician staffing were examined to explore whether team care accounted for differences in patient outcomes. After adjustment for patient characteristics and interactions, there was no association between team care and mortality for medical patients. Among surgical patients, multidisciplinary care was associated with a survival benefit (odds ratio 0.79; 95% confidence interval (CI), 0.62-1.00; P = .05). When stratifying by intensity of physician staffing, although the lowest odds of death were observed for surgical patients cared for in ICUs with multidisciplinary teams and high-intensity staffing (odds ratio, 0.77; 95% CI, 0.55-1.09; P = .15), followed by ICUs with multidisciplinary teams and low-intensity staffing (odds ratio 0.84, 95% CI 0.65-1.09, p = 0.19), these differences were not statistically significant. Our results suggest that multidisciplinary team care may improve outcomes for critically ill surgical patients. However, no relationship was observed between intensity of

  11. Human resource management in general practice: survey of current practice.

    PubMed Central

    Newton, J; Hunt, J; Stirling, J

    1996-01-01

    BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters

  12. The effect of physician staffing model on patient outcomes in a medical progressive care unit.

    PubMed

    Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

    2016-04-01

    Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. 45 CFR 303.20 - Minimum organizational and staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Minimum organizational and staffing requirements. 303.20 Section 303.20 Public Welfare Regulations Relating to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF...

  14. 75 FR 77665 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-13

    ..., Including On-Site Leased Workers From Career Solutions TEC Staffing and Andrews International, Fort Smith... Staffing, Fort Smith, Arkansas. The notice was published in the Federal Register on October 25, 2010 (75 FR... reports that workers leased from Andrews International were employed on-site at the Fort Smith, Arkansas...

  15. Nursing Home Quality, Cost, Staffing, and Staff Mix

    ERIC Educational Resources Information Center

    Rantz, Marilyn J.; Hicks, Lanis; Grando, Victoria; Petroski, Gregory F.; Madsen, Richard W.; Mehr, David R.; Conn, Vicki; Zwygart-Staffacher, Mary; Scott, Jill; Flesner, Marcia; Bostick, Jane; Porter, Rose; Maas, Meridean

    2004-01-01

    Purpose: The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. Design and Methods: A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing…

  16. Staffing Levels in the Dallas Independent School District

    ERIC Educational Resources Information Center

    Council of the Great City Schools, 2009

    2009-01-01

    The Board of Trustees of the Dallas Independent School District (DISD) asked the Council of the Great City Schools, the nation's primary coalition of large urban school systems, to examine the staffing levels of the school system and determine whether the numbers of staff members employed were appropriate for a district serving as many students as…

  17. Individual differences and day-to-day fluctuations in goal planning and type 1 diabetes management.

    PubMed

    Wiebe, Deborah J; Baker, Ashley C; Suchy, Yana; Stump, Tammy K; Berg, Cynthia A

    2018-04-26

    To examine whether individual differences and day-to-day fluctuations in diabetes goal planning are associated with Type 1 diabetes (T1D) management during late adolescence, and whether lapses in daily diabetes goal planning are more disruptive to diabetes management among those with poorer executive functioning (EF). Late adolescents with T1D (N = 236, Mage = 17.77 years) completed survey measures assessing individual differences in levels of diabetes goal planning and adherence, as well as survey and performance-based measures of EF; glycemic control was assessed through glycated hemoglobin (HbA1c) assays. Participants then completed a 2-week daily diary, rating items measuring daily diabetes goal planning, goal effort, and adherence, and recording blood-glucose tests from their glucometer at the end of each day. Analyses of survey measures indicated that higher individual differences in diabetes goal planning were associated with better adherence and glycemic control. Analyses of daily data using hierarchical linear modeling indicated that adolescents displayed higher daily adherence and lower blood-glucose levels on days when they had higher-than-their-average levels of daily goal planning and daily goal effort. EF moderated the association between daily goal planning and daily adherence, indicating that lapses in daily goal planning were more disruptive for adolescents with poorer EF. Both individual differences and day-to-day fluctuations in diabetes goal planning are associated with diabetes management, highlighting the challenges of managing T1D in daily life. Youth in late adolescence with poorer EF may especially benefit from planning to attain diabetes goals on a daily basis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  18. Why Employers Use Flexible Staffing Arrangements: Evidence from an Establishment Survey. Upjohn Institute Staff Working Paper.

    ERIC Educational Resources Information Center

    Houseman, Susan N.

    Use of flexible staffing arrangements--including temporary help agency, short-term, on-call, regular part-time, and contract workers--is widespread and two-thirds of employers believe this trend will increase in the near future. A study examined which employers use flexible staffing arrangements, why they use these arrangements, and their…

  19. Personnel Management. Universities.

    ERIC Educational Resources Information Center

    Ohio Board of Regents, Columbus. Management Improvement Program.

    This manual is one of 10 completed in the Ohio Management Improvement Program (MIP) during the 1971-73 biennium. In this project, Ohio's 34 public universities and colleges, in an effort directed and staffed by the Ohio Board of Regents, have developed manuals of management practices, in this case, concerning personnel management. Emphasis in this…

  20. Staffing UK University Campuses Overseas: Lessons from MNE Practice

    ERIC Educational Resources Information Center

    Salt, John; Wood, Peter

    2014-01-01

    This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…

  1. Cash balance plans: helping employers meet today's staffing needs.

    PubMed

    Hoeffner, S J

    2001-01-01

    The author examines how cash balance plans better meet employers' staffing needs than traditional pension plans. He asserts that out-of-date pension laws, rather than employers, are responsible for creating the very "abuses" that so many are complaining about with regard to cash balance plan conversions.

  2. 34 CFR 364.23 - What are the staffing requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false What are the staffing requirements? 364.23 Section 364.23 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE INDEPENDENT LIVING SERVICES PROGRAM AND...

  3. 34 CFR 364.23 - What are the staffing requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true What are the staffing requirements? 364.23 Section 364.23 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE INDEPENDENT LIVING SERVICES PROGRAM AND...

  4. QuickStats: Distribution of Long-Term Care Staffing* Hours,(†) by Staff Member Type and Sector - United States, 2014.

    PubMed

    2016-04-29

    In 2014, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 60% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%). Aides accounted for 75% of all staffing hours in residential care communities, in contrast to activities staff members (11%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%). In adult day services centers, aides provided 41% of all staffing hours, followed by activities staff members (32%), registered nurses (12%), licensed practical or vocational nurses (9%), and social workers (6%).

  5. Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies.

    PubMed

    Harrington, Charlene; Olney, Brian; Carrillo, Helen; Kang, Taewoon

    2012-02-01

    To compare staffing levels and deficiencies of the 10 largest U.S. for-profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after purchase by four private equity (PE) companies. Facilities for the largest for-profit chains were identified through Internet searches and company reports and matched with federal secondary data for 2003-2008 for each ownership group. Descriptive statistics and generalized estimation equation panel regression models examined staffing and deficiencies by ownership groups in the 2003-2008 period, controlling for facility characteristics, resident acuity, and market factors with state fixed effects. The top 10 for-profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for-profit facilities also had lower staffing and higher deficiencies than government facilities. The chains purchased by PE companies showed little change in staffing levels, but the number of deficiencies and serious deficiencies increased in some postpurchase years compared with the prepurchase period. There is a need for greater study of large for-profit chains as well as those chains purchased by PE companies. © Health Research and Educational Trust.

  6. The Development of Effective Staffing Structures in Higher Education.

    ERIC Educational Resources Information Center

    Absalom, Roger; Sutton, Clive

    1992-01-01

    Interviews with faculty at 10 European universities examined 2 issues in developing effective staffing structures: (1) possible barriers to vertical and horizontal mobility caused by a worsening environment; and (2) the possibility of value-dissonance for staff as a consequence of new requirements. Clear identification of responsibility for…

  7. Staffing and organisation of nursing care in cardiac intensive care units in Greece.

    PubMed

    Merkouris, Anastasios; Papathanassoglou, Elizabeth D E; Pistolas, Dimitrios; Papagiannaki, Vasileia; Floros, John; Lemonidou, Chryssoula

    2003-07-01

    To explore staffing and organisational characteristics of nursing care in cardiac intensive care units (CICUs) in Greece. An exploratory descriptive survey design with additional cross-sectional comparisons was employed. A specifically developed survey-type questionnaire, addressed to nurse managers, was distributed to all CICUs in Greece. The response rate was 76.2% (N=32 units). Nursing staff per bed ratios over 24 h (whole-time equivalent) were very low and exhibited a mean of 1.25 (+/-0.53). The total registered nurse to assistance nurse (RN/AN) ratio was 2.74, but a lot of variability was observed and in many units ANs operated in RNs positions. Only 42% of the nurses had participated at in-service continuing education programs and a systematic training program in cardio pulmonary resuscitation (CPR) was provided in only 12 (37.5%) units. The reported frequencies at which specific technical tasks were performed autonomously by nurses varied substantially and reflected a medium to low level of practice autonomy; the most frequently reported tasks were: peripheral IV line insertion, CPR chest compression, titration of vasoactive drugs and administration of analgesics. Higher percentages of nurses had received in-service training associated with the likelihood of performance of several technical tasks (P<0.03). Future studies need to explore the effect of these organisational characteristics on patient outcomes. The endorsement of nation-wide standards for nursing staffing and training in CICUs is imperative.

  8. Determinants and Effects of Nurse Staffing Intensity and Skill Mix in Residential Care/Assisted Living Settings

    ERIC Educational Resources Information Center

    Stearns, Sally C.; Park, Jeongyoung; Zimmerman, Sheryl; Gruber-Baldini, Ann L.; Konrad, Thomas R.; Sloane, Philip D.

    2007-01-01

    Purpose: Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes.…

  9. Comparing Staffing Levels in the Online Survey Certification and Reporting (OSCAR) System with the Medicaid Cost Report Data: Are Differences Systematic?

    ERIC Educational Resources Information Center

    Kash, Bita A.; Hawes, Catherine; Phillips, Charles D.

    2007-01-01

    Purpose: This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR. Design and Methods: We…

  10. Registered Nurse Staffing in Pennsylvania Nursing Homes: Comparison before and after Implementation of Medicare's Prospective Payment System.

    ERIC Educational Resources Information Center

    Kanda, Katsuya; Mezey, Mathy

    1991-01-01

    Examined changes in resident acuity and registered nurse staffing in all nursing homes in Pennsylvania before and after introduction of Medicare Prospective Payment System (PPS) in 1983. Found that acuity of nursing home residents increased significantly since introduction of PPS, full-time registered nurse staffing remained unchanged, and…

  11. New Directions for Academic Libraries in Research Staffing: A Case Study at National University of Ireland Galway

    ERIC Educational Resources Information Center

    Cox, John

    2017-01-01

    New research needs, global developments and local shifts in emphasis are demanding a broader range of interactions by librarians with researchers and are challenging previous staffing structures. Research has a higher institutional profile and academic libraries have responded by creating new roles and staffing models, with stronger linkage across…

  12. Stabilizing effects in temporal fluctuations: management, traits, and species richness in high-diversity communities.

    PubMed

    Lepš, Jan; Májeková, Maria; Vítová, Alena; Doležal, Jiří; de Bello, Francesco

    2018-02-01

    The loss of biodiversity is thought to have adverse effects on multiple ecosystem functions, including the decline of community stability. Decreased diversity reduces the strength of the portfolio effect, a mechanism stabilizing community temporal fluctuations. Community stability is also expected to decrease with greater variability in individual species populations and with synchrony of their fluctuations. In semi-natural meadows, eutrophication is one of the most important drivers of diversity decline; it is expected to increase species fluctuations and synchrony among them, all effects leading to lower community stability. With a 16-year time series of biomass data from a temperate species-rich meadow with fertilization and removal of the dominant species, we assessed population biomass temporal (co)variation under different management types and competition intensity, and in relation to species functional traits and to species diversity. Whereas the effect of dominant removal was relatively small (with a tendency toward lower stability), fertilization markedly decreased community stability (i.e., increased coefficient of variation in the total biomass) and species diversity. On average, the fluctuations of individual populations were mutually independent, with a slight tendency toward synchrony in unfertilized plots, and a tendency toward compensatory dynamics in fertilized plots and no effects of removal. The marked decrease of synchrony with fertilization, contrary to the majority of the results reported previously, follows the predictions of increased compensatory dynamics with increased asymmetric competition for light in a more productive environment. Synchrony increased also with species functional similarity stressing the importance of shared ecological strategies in driving similar species responses to weather fluctuations. As expected, the decrease of temporal stability of total biomass was mainly related to the decrease of species richness, with its

  13. Nurse Staffing and Deficiencies in the Largest For-Profit Nursing Home Chains and Chains Owned by Private Equity Companies

    PubMed Central

    Harrington, Charlene; Olney, Brian; Carrillo, Helen; Kang, Taewoon

    2012-01-01

    Objective To compare staffing levels and deficiencies of the 10 largest U.S. for-profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after purchase by four private equity (PE) companies. Data Sources Facilities for the largest for-profit chains were identified through Internet searches and company reports and matched with federal secondary data for 2003–2008 for each ownership group. Study Design Descriptive statistics and generalized estimation equation panel regression models examined staffing and deficiencies by ownership groups in the 2003–2008 period, controlling for facility characteristics, resident acuity, and market factors with state fixed effects. Principal Findings The top 10 for-profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for-profit facilities also had lower staffing and higher deficiencies than government facilities. The chains purchased by PE companies showed little change in staffing levels, but the number of deficiencies and serious deficiencies increased in some postpurchase years compared with the prepurchase period. Conclusions There is a need for greater study of large for-profit chains as well as those chains purchased by PE companies. PMID:22091627

  14. Staffing the Principalship: Finding, Coaching, and Mentoring School Leaders

    ERIC Educational Resources Information Center

    Lovely, Suzette

    2004-01-01

    "Help Wanted" signs are springing up outside schools. The shortage of school administrators is not coming, it is here. To thwart the shortage and keep schools on the cutting edge, diligence in cultivating, training, and inspiring a new generation of school leaders--especially for the principalship, must be exercised. Staffing the Principalship…

  15. Interlibrary Loan Trends: Staffing and Organization. SPEC Kit #187.

    ERIC Educational Resources Information Center

    Dearie, Tammie Nickelson, Comp.; Steel, Virginia, Comp.

    Topics related to research library interlibrary loan staffing and organizational structures were explored through a survey conducted by the Systems and Procedures Exchange Center (SPEC) of the Association of Research Libraries. Data gathered from 82 libraries show a very small increase in the number of full-time equivalents in loan units between…

  16. Nurse staffing levels and outcomes - mining the UK national data sets for insight.

    PubMed

    Leary, Alison; Tomai, Barbara; Swift, Adrian; Woodward, Andrew; Hurst, Keith

    2017-04-18

    Purpose Despite the generation of mass data by the nursing workforce, determining the impact of the contribution to patient safety remains challenging. Several cross-sectional studies have indicated a relationship between staffing and safety. The purpose of this paper is to uncover possible associations and explore if a deeper understanding of relationships between staffing and other factors such as safety could be revealed within routinely collected national data sets. Design/methodology/approach Two longitudinal routinely collected data sets consisting of 30 years of UK nurse staffing data and seven years of National Health Service (NHS) benchmark data such as survey results, safety and other indicators were used. A correlation matrix was built and a linear correlation operation was applied (Pearson product-moment correlation coefficient). Findings A number of associations were revealed within both the UK staffing data set and the NHS benchmarking data set. However, the challenges of using these data sets soon became apparent. Practical implications Staff time and effort are required to collect these data. The limitations of these data sets include inconsistent data collection and quality. The mode of data collection and the itemset collected should be reviewed to generate a data set with robust clinical application. Originality/value This paper revealed that relationships are likely to be complex and non-linear; however, the main contribution of the paper is the identification of the limitations of routinely collected data. Much time and effort is expended in collecting this data; however, its validity, usefulness and method of routine national data collection appear to require re-examination.

  17. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    PubMed Central

    Logani, Sachin; Green, Adam; Gasperino, James

    2011-01-01

    The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

  18. Healthcare security staffing for smaller facilities: where science meets art.

    PubMed

    Warren, Bryan

    2013-01-01

    Obtaining effective security resourcing and staffing for smaller healthcare facilities presents many difficulties, according to the author In this article, he provides guidance to security practitioners on taking existing data and translating it into a language that administration will understand and appreciate.

  19. 45 CFR 1336.65 - Staffing and organization of the Revolving Loan Fund: Responsibilities of the Loan Administrator.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... organization table, including: (a) The structure and composition of the Board of Directors of the RLF; (b) The... 45 Public Welfare 4 2010-10-01 2010-10-01 false Staffing and organization of the Revolving Loan... Hawaiian Revolving Loan Fund Demonstration Project § 1336.65 Staffing and organization of the Revolving...

  20. Concurrent and lagged effects of registered nurse turnover and staffing on unit-acquired pressure ulcers.

    PubMed

    Park, Shin Hye; Boyle, Diane K; Bergquist-Beringer, Sandra; Staggs, Vincent S; Dunton, Nancy E

    2014-08-01

    We examined the concurrent and lagged effects of registered nurse (RN) turnover on unit-acquired pressure ulcer rates and whether RN staffing mediated the effects. Quarterly unit-level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10,935 unit-quarter observations (2,294 units, 465 hospitals) were analyzed. This longitudinal study used multilevel regressions and tested time-lagged effects of study variables on outcomes. The lagged effect of RN turnover on unit-acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage-point increase in RN turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher RN turnover in a quarter was associated with lower RN staffing in the current and subsequent quarters. Higher RN staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers. We suggest that RN turnover is an important factor that affects pressure ulcer rates and RN staffing needed for high-quality patient care. Given the high RN turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes. © Health Research and Educational Trust.

  1. Concurrent and Lagged Effects of Registered Nurse Turnover and Staffing on Unit-Acquired Pressure Ulcers

    PubMed Central

    Park, Shin Hye; Boyle, Diane K; Bergquist-Beringer, Sandra; Staggs, Vincent S; Dunton, Nancy E

    2014-01-01

    Objective We examined the concurrent and lagged effects of registered nurse (RN) turnover on unit-acquired pressure ulcer rates and whether RN staffing mediated the effects. Data Sources/Setting Quarterly unit-level data were obtained from the National Database of Nursing Quality Indicators for 2008 to 2010. A total of 10,935 unit-quarter observations (2,294 units, 465 hospitals) were analyzed. Methods This longitudinal study used multilevel regressions and tested time-lagged effects of study variables on outcomes. Findings The lagged effect of RN turnover on unit-acquired pressure ulcers was significant, while there was no concurrent effect. For every 10 percentage-point increase in RN turnover in a quarter, the odds of a patient having a pressure ulcer increased by 4 percent in the next quarter. Higher RN turnover in a quarter was associated with lower RN staffing in the current and subsequent quarters. Higher RN staffing was associated with lower pressure ulcer rates, but it did not mediate the relationship between turnover and pressure ulcers. Conclusions We suggest that RN turnover is an important factor that affects pressure ulcer rates and RN staffing needed for high-quality patient care. Given the high RN turnover rates, hospital and nursing administrators should prepare for its negative effect on patient outcomes. PMID:24476194

  2. Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes.

    PubMed

    Roberts, Amy Restorick; Bowblis, John R

    2017-02-01

    Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.

  3. Staffing of Teaching and Learning Centers in the United States: Indicators of Institutional Support for Faculty Development

    ERIC Educational Resources Information Center

    Herman, Jennifer H.

    2013-01-01

    This quantitative study reports data from nearly 200 teaching and learning development units (TLDUs), regarding their current staffing levels compared to the number of FTE faculty and FTE student enrollment. The study found that these staffing ratios at primary TLDUs vary by both institutional control and by Carnegie classification: in general,…

  4. Librarianship and Information Work: Job Characteristics and Staffing Needs.

    ERIC Educational Resources Information Center

    Sergean, R.

    This report is an analysis of an investigation of staffing requirements for librarianship and information work carried out between 1972 and 1975 under the title of Sheffield Manpower Project. The results of the administration of a job descriptive questionnaire to members in a representative 45 per cent sample of libraries and information units (19…

  5. Lower Mortality for Abdominal Aortic Aneurysm Repair in High-Volume Hospitals Is Contingent upon Nurse Staffing

    PubMed Central

    Wiltse Nicely, Kelly L; Sloane, Douglas M; Aiken, Linda H

    2013-01-01

    Objective To determine whether and to what extent the lower mortality rates for patients undergoing abdominal aortic aneurysm (AAA) repair in high-volume hospitals is explained by better nursing. Data Sources State hospital discharge data, Multi-State Nursing Care and Patient Safety Survey, and hospital characteristics from the AHA Annual Survey. Study Design Cross-sectional analysis of linked patient outcomes for individuals undergoing AAA repair in four states. Data Collection Secondary data sources. Principal Findings Favorable nursing practice environments and higher hospital volumes of AAA repair are associated with lower mortality and fewer failures-to-rescue in main-effects models. Furthermore, nurse staffing interacts with volume such that there is no mortality advantage observed in high-volume hospitals with poor nurse staffing. When hospitals have good nurse staffing, patients in low-volume hospitals are 3.4 times as likely to die and 2.6 times as likely to die from complications as patients in high-volume hospitals (p < .001). Conclusions Nursing is part of the explanation for lower mortality after AAA repair in high-volume hospitals. Importantly, lower mortality is not found in high-volume hospitals if nurse staffing is poor. PMID:23088426

  6. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

    PubMed

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

    2014-02-01

    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  7. Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

    PubMed

    Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

    2015-04-01

    (1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  8. 77 FR 53913 - River Bend Industries, LLC, Including On-Site Leased Workers From FirstStaff, Trac Staffing, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-04

    ..., LLC, Including On-Site Leased Workers From FirstStaff, Trac Staffing, and Worksource, Inc., Fort Smith... Staffing, Worksource, Inc., Fort Smith, Arkansas. The Department's notice of determination was published in... Worksource, Inc. were employed on-site at the Fort Smith, Arkansas location of River Bend Industries, LLC...

  9. The Association Between Daytime Intensivist Physician Staffing and Mortality in the Context of Other ICU Organizational Practices: A Multicenter Cohort Study.

    PubMed

    Costa, Deena Kelly; Wallace, David J; Kahn, Jeremy M

    2015-11-01

    Daytime intensivist physician staffing is associated with improved outcomes in the ICU. However, it is unclear whether this association persists in the era of interprofessional, protocol-directed critical care. We sought to reexamine the association between daytime intensivist physician staffing and ICU mortality and determine if interprofessional rounding and protocols for mechanical ventilation in part mediate this relationship. Retrospective cohort study of ICUs in the Acute Physiology and Chronic Health Evaluation clinical information system from 2009 to 2010. Forty-nine ICUs in 25 U.S. hospitals. Adults (17 yr and older) admitted to a study ICU. None. We defined high-intensity daytime intensivist staffing as either a mandatory consult or closed ICU model; interprofessional rounds as rounds that included a respiratory therapist, pharmacist, physician and nurse; and protocol use as having protocols for liberation from mechanical ventilation and lung protective mechanical ventilation. Using multivariable logistic regression, we estimated the independent effect of daytime intensivist physician staffing on in-hospital mortality controlling for interprofessional rounds and protocols for mechanical ventilation, as well as other patient and hospital characteristics. Twenty-seven ICUs (55%) reported high-intensity daytime physician staffing, 42 ICUs (85%) reported daily interprofessional rounds, and 31 (63%) reported having protocols for mechanical ventilation. There was no association between daytime intensivist physician staffing and in-hospital mortality (adjusted odds ratio, 0.86; 95% CI, 0.65-1.14). After adjusting for interprofessional rounds and protocols for mechanical ventilation, the effect of daytime intensivist physician staffing remained nonsignificant (adjusted odds ratio, 0.90; 95% CI, 0.70-1.17). High-intensity daytime physician staffing in the ICU was not significantly associated with lower mortality in a modern cohort. This association was not

  10. On the Threshold of Safety: A Qualitative Exploration of Nurses' Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments.

    PubMed

    Wolf, Lisa A; Perhats, Cydne; Delao, Altair M; Clark, Paul R; Moon, Michael D

    2017-03-01

    The emergency department is a unique practice environment in that the Emergency Medical Treatment and Active Labor Act (EMTALA), which mandates a medical screening examination for all presenting patients, effectively precludes any sort of patient volume control; staffing needs are therefore fluid and unpredictable. The purpose of this study is to explore emergency nurses' perceptions of factors involved in safe staffing levels and to identify factors that negatively and positively influence staffing levels and might lend themselves to more effective interventions and evaluations. We used a qualitative exploratory design with focus group data from a sample of 26 emergency nurses. Themes were identified using a constructivist perspective and an inductive approach to content analysis. Five themes were identified: (1) unsafe environment of care, (2) components of safety, (3) patient outcomes: risky care, (4) nursing outcomes: leaving the profession, and (5) possible solutions. Participants reported that staffing levels are determined by the number of beds in the department (as in inpatient units) but not by patient acuity or the number of patients waiting for treatment. Participants identified both absolute numbers of staff, as well as experience mix, as components of safe staffing. Inability to predict the acuity of patients waiting to be seen was a major component of nurses' perceptions of unsafe staffing. Emergency nurses perceive staffing to be inadequate, and therefore unsafe, because of the potential for poor patient outcomes, including missed or delayed care, missed deterioration (failure to rescue), and additional ED visits resulting from ineffective discharge teaching. Both absolute numbers of staff, as well as skill and experience mix, should be considered to provide staffing levels that promote optimal patient and nurse outcomes. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  11. Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy.

    PubMed

    Weiner, Jonathan P

    2004-01-01

    This paper describes staffing at eight large prepaid group practices (PGPs) serving more than eight million enrollees at Kaiser Permanente and two other health maintenance organizations (HMOs). Even after characteristics of the patient populations and outside referrals are accounted for, these PGPs have a physician-to-population ratio that is 22-37 percent below the national rate. Two decades of historical data at Kaiser Permanente indicate that its rate of specialist growth was far higher than that of primary care. The study suggests that efficient systems of care can readily meet the demands of patient populations with workforce staffing ratios below current U.S. levels.

  12. Consultant management estimating tool.

    DOT National Transportation Integrated Search

    2012-04-01

    The New York State Department of Transportation (NYSDOT) Consultant Management Bureaus primary responsibilities are to negotiate staffing hours/resources with : engineering design consultants, and to monitor the consultant's costs. Currently the C...

  13. What Is Effective School Management.

    ERIC Educational Resources Information Center

    De Cicco, James M.

    Effective school management requires managers who succeed in carrying out the organizational goals of their schools, utilizing the following leadership skills: planning (deciding how to accomplish the organization's goals); organizing (doing the necessary preparation); staffing (filling positions with the right people); directing (motivating staff…

  14. The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and nonsafety net hospitals.

    PubMed

    Lindrooth, Richard C; Bazzoli, Gloria J; Needleman, Jack; Hasnain-Wynia, Romana

    2006-06-01

    The financial savings from the Balanced Budget Act (BBA) are attractive to policy makers, but such savings come at a cost. We measure changes in nurse staffing at hospitals related to potential declines in reimbursement through the BBA. Following Hadley, Zuckerman, and Feder (1989), we define a fiscal pressure index (FPI) to measure the differential effect of the BBA. We estimate the effect of the FPI on the number of full-time equivalent registered nurses (RN) and licensed practical nurses (LPN) per adjusted patient day using American Hospital Association (AHA) data of a panel of hospitals from 1996 to 2001. The AHA data are combined with the Area Resource Files and health maintenance organizations penetration data. We control for hospital heterogeneity using fixed effects. All urban short-term general hospitals that responded to the staffing and uncompensated care questions in the AHA survey between 1996 and 2001. We define safety net hospitals as those with a high ratio of uncompensated costs to total hospital expenses (see, e.g., Zuckerman et al. 2001). We find that the nonsafety net hospitals that were most susceptible to the provisions of the BBA experienced a decline in RN staffing ratios about twice the rate of the nonsafety net hospitals that were least susceptible to the BBA. We are unable to detect an effect of the BBA on staffing at safety net hospitals. RN and LPN staffing levels per adjusted patient day declined, on average, between 1996 and 2001. Within the context of the general decline, we find that RN staffing per adjusted patient day declined even more at nonsafety net hospitals that were most susceptible to lower reimbursement related to the BBA. Thus, there was a small but statistically significant incremental effect of potential BBA losses on RN staffing at hospitals that were expected to be affected most. This incremental decline represented about a 6 percent increase in nurse workload that in isolation might not affect quality. Nevertheless

  15. SCAR Radiologic Technologist Survey: analysis of technologist workforce and staffing.

    PubMed

    Reiner, Bruce; Siegel, Eliot; Carrino, John A; McElveny, Ceela

    2002-09-01

    One of the greatest dilemmas facing medical imaging departments today is the worsening personnel crisis in the radiologic technologist (RT) workforce. As the volume and complexity of medical imaging studies continues to increase, an unprecedented imbalance exists between RT supply and demand. A number of etiologic factors have been postulated to contribute to this RT shortage including decreasing morale, perceived inadequacies in compensation, decreasing number of training programs, and limitations in the career ladder. Previous studies have cited improved technologist productivity as imaging departments successfully transition from film-based to filmless operation. This study was undertaken to address the impact of digital technologies (information systems, PACS, digital radiography) on technologist productivity, in an attempt to determine whether these technologies can be used to positively affect the existing RT workforce imbalance. A total of 112 facilities participated in this nationwide study, with representation of imaging providers that paralleled the demographic profile of the marketplace as a whole. Survey results indicate the existing RT staffing shortage is greatest within academic and rural-based hospitals and is most severe in the area of general radiography, which accounts for 65-70% of imaging department volumes. For general radiography alone, respondents report an average shortage of 2 RT full-time equivalents (FTE's) per institution, when comparing the number of budgeted RT FTE's versus the actual number of RT FTE's. Preliminary results indicate that at this time, RT staffing shortages are not affected by the presence or absence of digital information technologies. Additional research is planned through a five-year longitudinal data collection, to better delineate the complex relationship that exists between implementation of digital technologies and RT staffing.

  16. The Selenocysteine tRNA STAF-Binding Region is Essential for Adequate Selenocysteine tRNA Status, Selenoprotein Expression and Early Age Survival of Mice

    USDA-ARS?s Scientific Manuscript database

    STAF is a transcription activating factor for a number of RNA Pol III-and RNA Pol II-dependent genes including the selenocysteine (Sec) tRNA gene. Here, the role of STAF in regulating expression of Sec tRNA and selenoproteins was examined in an invivo model. Heterozygous inactivation of the Staf gen...

  17. Reduced Mortality by Physician-Staffed HEMS Dispatch for Adult Blunt Trauma Patients in Korea

    PubMed Central

    2016-01-01

    The aim of this study was to investigate the efficiency of domestic physician-staffed helicopter emergency medical service (HEMS) for the transport of patients with severe trauma to a hospital. The study included patients with blunt trauma who were transported to our hospital by physician-staffed HEMS (Group P; n = 100) or nonphysician-staffed HEMS (Group NP; n = 80). Basic patient characteristics, transport time, treatment procedures, and medical treatment outcomes assessed using the Trauma and Injury Severity Score (TRISS) were compared between groups. We also assessed patients who were transported to the hospital within 3 h of injury in Groups P (Group P3; n = 50) and NP (Group NP3; n = 74). The severity of injury was higher, transport time was longer, and time from hospital arrival to operation room transfer was shorter for Group P than for Group NP (P < 0.001). Although Group P patients exhibited better medical treatment outcomes compared with Group NP, the difference was not statistically significant (P = 0.134 vs. 0.730). However, the difference in outcomes was statistically significant between Groups P3 and NP3 (P = 0.035 vs. 0.546). Under the current domestic trauma patient transport system in South Korea, physician-staffed HEMS are expected to increase the survival of patients with severe trauma. In particular, better treatment outcomes are expected if dedicated trauma resuscitation teams actively intervene in the medical treatment process from the transport stage and if patients are transported to a hospital to receive definitive care within 3 hours of injury. PMID:27550497

  18. Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

    PubMed Central

    Weiss, Manfred; Marx, Gernot; Iber, Thomas

    2017-01-01

    Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician’s workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs. PMID:28828300

  19. Generalizable items and modular structure for computerised physician staffing calculation on intensive care units.

    PubMed

    Weiss, Manfred; Marx, Gernot; Iber, Thomas

    2017-08-04

    Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

  20. Adverse nurse outcomes: correlation to nurses' workload, staffing, and shift rotation in Kuwaiti hospitals.

    PubMed

    Al-Kandari, Fatimah; Thomas, Deepa

    2008-08-01

    This study was conducted to identify adverse outcomes to nurses in relation to their daily patient load, nursing care activities, staffing, and shift rotation. A structured questionnaire was used to collect data from medical and surgical nurses (N = 784). Skipping tea/coffee breaks (95%), feeling responsible for more patients than they could safely care for (87%), inadequate help available (86%), inadequate time to document care (80%), verbal abuse by a patient or a visitor (77%), and concern about quality of care (71%) were the major reported adverse outcomes related to short staffing, increased patient load, and increased nursing care activities.

  1. Obesity and intensive staffing needs of nursing home residents.

    PubMed

    Harris, John Alexander; Engberg, John; Castle, Nicholas George

    2018-06-05

    The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Applying science and strategy to operating room workforce management.

    PubMed

    Butler, Victoria; Clinton, Christopher; Sagi, Harsha K; Kenney, Robert; Barsoum, Wael K

    2012-01-01

    The traditional means of planning nurse staffing for operating rooms are either poorly translated to the setting or do not provide decision makers with a platform to defend their needs, especially in an era of health care reform. The surgical operations department of the Cleveland Clinic initiated a quality improvement project aimed at applying a scientific method to operating room staffing. One goal was to provide a defensible plan for allocating direct caregiver positions. A second goal was to provide a quick and easy way for nurse managers and directors to track positions and graphically depict the effect of vacancies and orientation on their staffing budgets. Using an objective, scientific method allows position requests to be approved quickly and allows managers to feel much more comfortable functioning in a "lean" mode because they know needed positions will be approved quickly. Managers and directors also have found that graphically depicting numbers of vacant positions, as well as staff in orientation, could quickly relate a story visually rather than getting "bogged down" in narrative (often losing finance administrators along the way).

  3. Managers Handbook for Software Development

    NASA Technical Reports Server (NTRS)

    Agresti, W.; Mcgarry, F.; Card, D.; Page, J.; Church, V.; Werking, R.

    1984-01-01

    Methods and aids for the management of software development projects are presented. The recommendations are based on analyses and experiences with flight dynamics software development. The management aspects of organizing the project, producing a development plan, estimation costs, scheduling, staffing, preparing deliverable documents, using management tools, monitoring the project, conducting reviews, auditing, testing, and certifying are described.

  4. Verifying detailed fluctuation relations for discrete feedback-controlled quantum dynamics

    NASA Astrophysics Data System (ADS)

    Camati, Patrice A.; Serra, Roberto M.

    2018-04-01

    Discrete quantum feedback control consists of a managed dynamics according to the information acquired by a previous measurement. Energy fluctuations along such dynamics satisfy generalized fluctuation relations, which are useful tools to study the thermodynamics of systems far away from equilibrium. Due to the practical challenge to assess energy fluctuations in the quantum scenario, the experimental verification of detailed fluctuation relations in the presence of feedback control remains elusive. We present a feasible method to experimentally verify detailed fluctuation relations for discrete feedback control quantum dynamics. Two detailed fluctuation relations are developed and employed. The method is based on a quantum interferometric strategy that allows the verification of fluctuation relations in the presence of feedback control. An analytical example to illustrate the applicability of the method is discussed. The comprehensive technique introduced here can be experimentally implemented at a microscale with the current technology in a variety of experimental platforms.

  5. Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation.

    PubMed

    Tucker, Janet

    2002-01-12

    UK recommendations suggest that large neonatal intensive-care units (NICUs) have better outcomes than small units, although this suggestion remains unproven. We assessed whether patient volume, staffing levels, and workload are associated with risk-adjusted outcomes, and with costs or staff wellbeing. 186 UK NICUs were stratified according to volume of patients, nursing provision, and neonatal consultant provision. Primary outcomes were hospital mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 13515 infants of all birthweights consecutively admitted to 54 randomly selected NICUs. Multiple logistic regression analyses were done with every primary outcome as the dependent variable. Staff wellbeing and stress were assessed by anonymous mental health index (MHI)-5 questionnaires. Data were available for 13334 (99%) infants. High-volume NICUs treated the sickest infants and had highest crude mortality. Risk-adjusted mortality and mortality or cerebral damage were unrelated to patient volume or staffing provision; however, nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was raised with increasing workload in all types of NICUs. Infants admitted at full capacity versus half capacity were about 50% more likely to die, but there was wide uncertainty around this estimate. Most staff had MHI-5 scores that suggested good mental health. The implications of this report for staffing policy, medicolegal risk management, and ethical practice remain to be tested. Centralisation of only the sickest infants could improve efficiency, provided that this does not create excessive workload for staff. Assessment of increased staffing levels that are closer to those in adult intensive care might be appropriate.

  6. Of Dirty Sheets and Worse: Administration Costs and Staffing Matters.

    ERIC Educational Resources Information Center

    Keigher, Sharon M.

    1993-01-01

    Considers article written by professor of social welfare in 1981 in which job security of social workers is addressed. Compares views expressed in 1981 with situation faced by social workers today. Considers danger of administration costs resulting in short-staffing of hospitals serving the poor and discusses case of 22-year-old obstetrics patient…

  7. AASL Position Statement on Appropriate Staffing for School Library Media Centers.

    ERIC Educational Resources Information Center

    Emergency Librarian, 1994

    1994-01-01

    Presents the AASL (American Association of School Librarians) position statement on appropriate staffing for school library media centers. Highlights include the need for full-time, certified library media specialists; support staff; ratio of professional staff to teacher and student populations; and district library media directors. (LRW)

  8. Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay.

    PubMed

    de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W

    2014-04-01

    In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.

  9. Managing Custodial and Maintenance Staffs.

    ERIC Educational Resources Information Center

    Fickes, Michael

    2001-01-01

    Presents some basic maintenance management techniques that can help schools meet their budgets, preserve staffing levels, meet productivity needs, and sustain quality services. Tips for staff recruitment, training, and retention are explored. (GR)

  10. [Staffing levels in medical radiation physics in radiation therapy in Germany. Summary of a questionnaire].

    PubMed

    Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus

    2003-10-01

    To get a general idea of the actual staffing level situation in medical radiation physics in 1999 a survey was carried out by the task-group "Personalbedarf" of Deutsche Gesellschaft für Medizinische Physik (DGMP) among all DGMP-members who are active in this field. Main components for equipment and activities are defined in Report 8 and 10 of DGMP for staffing requirements in medical radiation physics. 322 forms were sent out, 173 of them have been evaluated. From the answers regarding equipment and activities numbers for staff are calculated by the methods given in Report 8 and 10 for this spot check target and compared with effective staffing levels. The data of the spot check are then extrapolated on total Germany. The result is a calculated deficit of 865 medical physicists for the whole physics staff, 166 of them in radiation therapy. From the age distribution of DGMP-members and the calculated deficit resulted a training capacity of about 100 medical physicists at all per year (19 in radiation therapy) if the deficit shall be cut back in 10 years.

  11. Teaching Principles of Management through Experiential and Service Learning

    ERIC Educational Resources Information Center

    Furutan, Omid

    2014-01-01

    Management faculties often use cases, simulations, and research projects to achieve learning objectives in the Principles of Management class. This class typically aims to introduce students to the topics of "planning, organizing, coordinating, staffing, directing, budgeting, controlling, and evaluating functions of management; leadership…

  12. Laying the Foundation: Institutional Research Office Organization, Staffing, and Career Development

    ERIC Educational Resources Information Center

    Leimer, Christina; Terkla, Dawn Geronimo

    2009-01-01

    Staffing is a fundamental component of effective institutional research, yet determining and securing adequate resources can be difficult. In addition, as was noted in an AIR Forum presentation on the Achieving the Dream project (Rincones and Champion, 2008), even when colleges allocate money for positions they have difficulty finding…

  13. 45 CFR 1321.9 - Organization and staffing of the State agency.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Organization and staffing of the State agency. 1321.9 Section 1321.9 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS...

  14. 45 CFR 1321.9 - Organization and staffing of the State agency.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Organization and staffing of the State agency. 1321.9 Section 1321.9 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS...

  15. Nursing and the Management Function.

    ERIC Educational Resources Information Center

    Sherman, V. Clayton

    The report describes a study designed to analyze nurses' management duties and to identify their tasks in planning, organizing, staffing. leading, communication, decision making, and controlling. A total of 117 supervisory nurses and unit managers from four Western Michigan short-term general hospitals in the 410-540 bed range participated in the…

  16. Effect of Staff Turnover on Staffing: A Closer Look at Registered Nurses, Licensed Vocational Nurses, and Certified Nursing Assistants

    ERIC Educational Resources Information Center

    Kash, Bita A.; Castle, Nicholas G.; Naufal, George S.; Hawes, Catherine

    2006-01-01

    Purpose: We examined the effects of facility and market-level characteristics on staffing levels and turnover rates for direct care staff, and we examined the effect of staff turnover on staffing levels. Design and Methods: We analyzed cross-sectional data from 1,014 Texas nursing homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost…

  17. Three metaphors and a (mis)quote: thinking about staffing-outcomes research, health policy and the future of nursing.

    PubMed

    Clarke, Sean P

    2009-03-01

    Conducting research on nurse staffing and outcomes is very challenging, and the application of staffing-outcomes research in practice is both fraught with controversy and vitally important for the safety of our patients and the future of the profession. As I stand back and think about being involved in staffing-outcomes research for nearly a decade and sharing many of my thoughts about this rapidly growing literature in reviews and commentaries in print, certain metaphors for trends in this field come to mind. I won't claim originality for the insights that follow or attempt to thoroughly trace the genealogy of the stories and metaphors here, but offer them to provide what I hope is a fresh perspective to material that I and many of my colleagues have visited and revisited on numerous occasions.

  18. 25 CFR 36.77 - What are the homeliving staffing requirements?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Night 1:40. High School (Gr. 7-12) Morning 1:20. During school As school needs. Evening 1:30. Night 1:50... 1-6) Morning/day 1:20. Evening 1:20. Night 1:40. High School (Gr. 7-12) Morning/day 1:40. Evening 1... meet the staffing requirements of this section. (a) Effective with the 2009-2010 school year, each...

  19. 25 CFR 36.77 - What are the homeliving staffing requirements?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Night 1:40. High School (Gr. 7-12) Morning 1:20. During school As school needs. Evening 1:30. Night 1:50... 1-6) Morning/day 1:20. Evening 1:20. Night 1:40. High School (Gr. 7-12) Morning/day 1:40. Evening 1... meet the staffing requirements of this section. (a) Effective with the 2009-2010 school year, each...

  20. 25 CFR 36.77 - What are the homeliving staffing requirements?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... Night 1:40. High School (Gr. 7-12) Morning 1:20. During school As school needs. Evening 1:30. Night 1:50... 1-6) Morning/day 1:20. Evening 1:20. Night 1:40. High School (Gr. 7-12) Morning/day 1:40. Evening 1... meet the staffing requirements of this section. (a) Effective with the 2009-2010 school year, each...

  1. 25 CFR 36.77 - What are the homeliving staffing requirements?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Night 1:40. High School (Gr. 7-12) Morning 1:20. During school As school needs. Evening 1:30. Night 1:50... 1-6) Morning/day 1:20. Evening 1:20. Night 1:40. High School (Gr. 7-12) Morning/day 1:40. Evening 1... meet the staffing requirements of this section. (a) Effective with the 2009-2010 school year, each...

  2. Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

    PubMed

    Rantz, Marilyn J; Hicks, Lanis; Petroski, Gregory F; Madsen, Richard W; Alexander, Greg; Galambos, Colleen; Conn, Vicki; Scott-Cawiezell, Jill; Zwygart-Stauffacher, Mary; Greenwald, Leslie

    2010-09-01

    There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

  3. Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

    PubMed

    Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H

    2015-02-01

    While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Effects of nurse staffing, work environments, and education on patient mortality: An observational study

    PubMed Central

    Cho, Eunhee; Sloane, Douglas M.; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H.

    2014-01-01

    Background While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. Objective To examine the effects of nurse staffing, work environment, and education on patient mortality. Methods This study linked hospital facility data with staff nurse survey data (N=1,024) and surgical patient discharge data (N = 76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Results Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00–1.10; OR 0.52, 95% CI 0.31–0.88; and OR 0.91, CI 0.83–0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in BSN nurse is associated with a 9% decrease in patient deaths. Conclusions Nurse staffing, nurse work environments, and percentages of BSN nurses in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of BSN nurses would help reduce the number of preventable in-hospital deaths. PMID:25213091

  5. Report on Staffing and Salaries, Fall 1988. Report Number 89-2.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    This report presents fall 1989 demographic, staffing, salary, and workload information on all California community college employees, based on data from 69 of the 71 districts in the state. First, tables present the total number of district employees by primary occupational activity; full-time equivalency; type of assignment; weekly faculty…

  6. Effects of domestic violence policies, alcohol taxes and police staffing levels on intimate partner homicide in large US cities.

    PubMed

    Zeoli, April M; Webster, Daniel W

    2010-04-01

    To assess the relationships between intimate partner homicide (IPH) and public policies including police staffing levels in large US cities. The research uses a multiple time-series design to examine the effects of statutes aimed at restricting access to firearms for perpetrators of domestic violence, allowing or mandating arrest for violators of domestic violence restraining orders (DVROs), beer excise taxes, and police staffing levels on IPH in 46 of the largest US cities from 1979 to 2003. Both total IPH and IPH committed with a firearm are analysed. Generalised estimating equations using a Poisson distribution are used to regress IPH on the policies and potential confounders. State statutes restricting those under DVROs from accessing firearms, and laws allowing the warrantless arrest of DVRO violators are associated with reductions in total and firearm IPH. Police staffing levels are also negatively associated with IPH and firearm IPH. There was no evidence that other policies to restrict firearm access to domestic violence offenders or alcohol taxes had a significant impact on IPH. Reducing access to firearms for DVRO defendants, increasing police staffing levels and allowing the warrantless arrest of DVRO violators may reduce the city-level risk of IPH. Future research should evaluate factors that may mediate the effect of these laws and increased police staffing levels on IPH to determine whether there are opportunities to increase their protective effect. Further research is needed on firearm law implementation to determine why the other tested laws were not found effective.

  7. Water-level fluctuations influence sediment porewater ...

    EPA Pesticide Factsheets

    Reservoirs typically have elevated fish mercury (Hg) levels compared to natural lakes and rivers. A unique feature of reservoirs is water-level management which can result in sediment exposure to the air. The objective of this study is to identify how reservoir water-level fluctuations impact Hg cycling, particularly the formation of the more toxic and bioaccumulative methylmercury (MeHg). Total-Hg (THg), MeHg, stable isotope methylation rates and several ancillary parameters were measured in reservoir sediments (including some in porewater and overlying water) that are seasonally and permanently inundated. The results showed that sediment and porewater MeHg concentrations were over 3-times higher in areas experiencing water-level fluctuations compared to permanently inundated sediments. Analysis of the data suggest that the enhanced breakdown of organic matter in sediments experiencing water-level fluctuations has a two-fold effect on stimulating Hg methylation: 1) it increases the partitioning of inorganic Hg from the solid phase into the porewater phase (lower log Kd values) where it is more bioavailable for methylation; and 2) it increases dissolved organic carbon (DOC) in the porewater which can stimulate the microbial community that can methylate Hg. Sulfate concentrations and cycling were enhanced in the seasonally inundated sediments and may have also contributed to increased MeHg production. Overall, our results suggest that reservoir management a

  8. California's minimum-nurse-staffing legislation and nurses' wages.

    PubMed

    Mark, Barbara; Harless, David W; Spetz, Joanne

    2009-01-01

    In 2004, California became the first state to implement minimum-nurse-staffing ratios in acute care hospitals. We examined the wages of registered nurses (RNs) before and after the legislation was enacted. Using four data sets-the National Sample Survey of Registered Nurses, the Current Population Survey, the National Compensation Survey, and the Occupational Employment Statistics Survey-we found that from 2000 through 2006, RNs in California metropolitan areas experienced real wage growth as much as twelve percentage points higher than the growth in the wages of nurses employed in metropolitan areas outside of California.

  9. Job satisfaction in relation to change to all-RN staffing.

    PubMed

    Lundgren, Solveig M; Nordholm, Lena; Segesten, Kerstin

    2005-07-01

    A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost. The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff. Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years. The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.

  10. Do Medicaid Wage Pass-through Payments Increase Nursing Home Staffing?

    PubMed Central

    Feng, Zhanlian; Lee, Yong Suk; Kuo, Sylvia; Intrator, Orna; Foster, Andrew; Mor, Vincent

    2010-01-01

    Objective To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes. Data Sources Online Survey Certification and Reporting (OSCAR) data, and state Medicaid nursing home reimbursement policies over the period 1996–2004. Study Design A fixed-effects panel model with two-step feasible-generalized least squares estimates is used to examine the effect of pass-through adoption on direct-care staff hours per resident day (HPRD) in nursing homes. Data Collection/Extraction Methods A panel data file tracking annual OSCAR surveys per facility over the study period is linked with annual information on state Medicaid wage pass-through and related policies. Principal Findings Among the states introducing wage pass-through over the study period, the policy is associated with between 3.0 and 4.0 percent net increases in certified nurse aide (CNA) HPRD in the years following adoption. No discernable pass-through effect is observed on either registered nurse or licensed practical nurse HPRD. Conclusions State Medicaid wage pass-through programs offer a potentially effective policy tool to boost direct-care CNA staffing in nursing homes, at least in the short term. PMID:20403054

  11. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital.

    PubMed

    McIntosh, Catherine; Dexter, Franklin; Epstein, Richard H

    2006-12-01

    In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

  12. Nursing Home Staffing and Quality under the Nursing Home Reform Act

    ERIC Educational Resources Information Center

    Zhang, Xinzhi; Grabowski, David C.

    2004-01-01

    Purpose: We examine whether the Nursing Home Reform Act (NHRA) improved nursing home staffing and quality. Design and Methods: Data from 5,092 nursing homes were linked across the 1987 Medicare/Medicaid Automated Certification System and the 1993 Online Survey, Certification and Reporting system. A dummy-year model was used to examine the effects…

  13. Broken down by Sex and Age: Australian University Staffing Patterns 1994-2003

    ERIC Educational Resources Information Center

    Dobson, Ian R.

    2006-01-01

    This article examines trends in Australian university staffing through an analysis of ten years' staff statistics, 1994-2003. An introduction which considers definitions, methodological issues, and overall changes in patterns of casualisation, sex and the distribution of academic and general ("non-academic") staff categories is followed…

  14. Contingency Base Camp Operations and Management: Staffing and Organization

    DTIC Science & Technology

    2013-09-17

    security, safety , environmental and health risks to deployed forces. This study was undertaken to address operations and management (O&M) requirements...security, safety , envi- ronmental and health risks to deployed forces. This study was undertaken to address operations and management (O&M) requirements... food service oversight • Joint Visitor Bureau ERDC/CERL TR-13-18 16 • MWR. TF Archer was significantly augmented with engineer personnel to

  15. Registered nurses' perceptions of nurse staffing ratios and new hospital payment regulations.

    PubMed

    Buerhaus, Peter I; Donelan, Karen; DesRoches, Catherine; Hess, Robert

    2009-01-01

    Two regulatory initiatives weigh heavily on the nursing workforce: establishing minimum patient-to-nurse staffing ratios in hospitals and payment policy that eliminates payment to hospitals for negative consequences of care. Although the majority of RNs favor ratios, results also indicate that a good number of RNs either do not support ratios or are unsure, which suggests that while strong support for ratios exists, the support is not universal. With regard to the Centers for Medicare and Medicaid Services hospital payment regulations, while many RNs expect that this policy change will increase the emphasis on prevention and additional education and training, RNs also believe they will be blamed if adverse patient conditions occur. A clear majority think that their work will increase, and only a small percentage of RNs think the regulations will lead to added respect, more staffing, higher pay, or raise their status. Beyond affecting the clinical environment, both regulations will impact RNs' economic value in the eyes of the hospitals that employ them.

  16. Rural Emergency Department Staffing and Participation in Emergency Certification and Training Programs

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Wholey, Douglas; Moscovice, Ira S.

    2008-01-01

    Context: The practice of emergency medicine presents many challenges in rural areas. Purpose: We describe how rural hospitals nationally are staffing their Emergency Departments (EDs) and explore the participation of rural ED physicians and other health care professionals in selected certification and training programs that teach skills needed to…

  17. Documentation for the 2011-12 Schools and Staffing Survey. NCES 2016-817

    ERIC Educational Resources Information Center

    Cox, Shawna; Parmer, Randall; Strizek, Gregory; Thomas, Teresa

    2017-01-01

    The overall objective of the Schools and Staffing Survey (SASS) is to collect the information necessary for a comprehensive picture of elementary and secondary education in the United States. The abundance of data collected permits detailed analyses of the characteristics of schools, principals, teachers, school libraries, and public school…

  18. Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study.

    PubMed

    Sunde, Geir Arne; Sandberg, Mårten; Lyon, Richard; Fredriksen, Knut; Burns, Brian; Hufthammer, Karl Ove; Røislien, Jo; Soti, Akos; Jäntti, Helena; Lockey, David; Heltne, Jon-Kenneth; Sollid, Stephen J M

    2017-07-11

    The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS. Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran-Mantel-Haenszel methods and mixed-effects models. Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO 2 compared to trauma patients. Post-intervention and admission SpO 2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4-5.4). Our results showed that non-trauma patients had a higher incidence of

  19. Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review.

    PubMed

    Goryakin, Yevgeniy; Griffiths, Peter; Maben, Jill

    2011-04-01

    Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future

  20. Documentation for the 2003-04 Schools and Staffing Survey. NCES 2007-337

    ERIC Educational Resources Information Center

    Tourkin, Steven C.; Warner, Toni; Parmer, Randall; Cole, Cornette; Jackson, Betty; Zukerberg, Andrew; Cox, Shawna; Soderberg, Andrew

    2007-01-01

    This report serves as the survey documentation for the design and implementation of the 2003-04 Schools and Staffing Survey. Topics covered include the sample design, survey methodology, data collection procedures, data processing, response rates, imputation procedures, weighting and variance estimation, review of the quality of data, the types of…

  1. Measuring the Implementation of Differentiated Staffing: A Comparison of Two Elementary Schools.

    ERIC Educational Resources Information Center

    Charters, W. W., Jr.

    Questionnaires were administered to the staffs of two elementary schools as part of a program to identify salient forces within schools that facilitate or inhibit the implementation of educational innovations. One school, an "experimental" school, was engaged in a district differentiated staffing project; the other, a "control" school, was a…

  2. Documentation for the 2007-08 Schools and Staffing Survey. NCES 2010-332

    ERIC Educational Resources Information Center

    Tourkin, Steven; Thomas, Teresa; Swaim, Nancy; Cox, Shawna; Parmer, Randall; Jackson, Betty; Cole, Cornette; Zhang, Bei

    2010-01-01

    The Schools and Staffing Survey (SASS) is conducted by the National Center for Education Statistics (NCES) on behalf of the United States Department of Education in order to collect extensive data on American public and private elementary and secondary schools. SASS provides data on the characteristics and qualifications of teachers and…

  3. Daddy's Gone to Colorado: Male-Staffed Child Care for Father-Absent Boys.

    ERIC Educational Resources Information Center

    Brody, Steve

    1978-01-01

    The article presents the goals, methods, and case examples of The Nutury, a predominantly male-staffed child care center serving single-parent children. The primary goal is to provide consistent relationships with men for children without a male model in their home. Clinical observations reveal positive life-styles and attitudes. (LPG)

  4. The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events.

    PubMed

    Cho, Eunhee; Chin, Dal Lae; Kim, Sinhye; Hong, OiSaeng

    2016-01-01

    The purpose of this study was to examine the relationships of nurse staffing level and work environment with patient adverse events. This cross-sectional study used a combination of nurse survey data (N = 4,864 nurses), facility data (N = 58 hospitals), and patient hospital discharge data (N = 113,426 patients) in South Korea. The three most commonly nurse-reported adverse events included administration of the wrong medication or dose to a patient, pressure ulcers, and injury from a fall after admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment (Practice Environment Scale of the Nursing Work Index) with patient adverse events after controlling for nurse, hospital, and patient characteristics. A larger number of patients per nurse was significantly associated with a greater incidence of administration of the wrong medication or dose (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 1.007-1.016), pressure ulcer (OR = 1.01, 95% CI = 1.007-1.016), and patient falls with injury (OR = 1.02, 95% CI = 1.013-1.022). A better work environment had a significant inverse relationship with adverse events; the odds of reporting a higher incidence of adverse events were 45% lower for administration of the wrong medication or dose (OR = 0.55, 95% CI = 0.400-0.758), followed by 39% lower for pressure ulcer (OR = 0.61, 95% CI = 0.449-0.834) and 32% lower for falls with injury after admission (OR = 0.68, 95% CI = 0.490-0.939). This study found that a larger number of patients per nurse and poor work environment increase the incidence of patient adverse events, such as administration of the wrong medication or dose to a patient, pressure ulcers, and injury from falling after admission. The findings suggest that South Korean hospitals could prevent patient adverse events by improving nurse staffing and work environment. Healthcare strategies and efforts to

  5. The Encouragement and Development of Women into Education Management.

    ERIC Educational Resources Information Center

    Gold, Anne

    In Great Britain, it is not unusual to find primary schools staffed almost entirely by women, but managed by men. This paper argues that more women should manage education in western Europe and explains why. It examines the stereotypes of "gendered" management styles. For example, both Margaret Thatcher and Bill Clinton have encountered…

  6. Using volunteers in Ontario hospital libraries: views of library managers.

    PubMed

    McDiarmid, Mary; Auster, Ethel

    2005-04-01

    Volunteers have been a resource for all types of libraries for many years. Little research has been done to describe the attitudes librarians have toward library volunteers. More specifically, the attitudes of hospital librarians toward volunteers have never been studied. The objective was to explore and describe the extent of volunteer use and to determine library managers' attitudes toward volunteers. An anonymous, self-report 38-item questionnaire was mailed to the target population of 89 hospital library managers in Ontario. Seventy-nine useable questionnaires were analyzed from an adjusted sample of 86 eligible respondents, resulting in a response rate of 92%. SPSS 11.5 was used to analyze the data. The data revealed the attitudes of managers using volunteers did not differ significantly from the attitudes of managers not using volunteers. The findings showed that a majority of managers did not believe their libraries were adequately staffed with paid employees. Sufficient evidence was found of an association between a manager's belief in the adequacy of staffing in the library and the use of volunteers in the library (chi2(1, N=76)=4.11, P=0.043). Specifically, volunteers were more likely to be used by managers who did not believe their libraries were adequately staffed. The presence of a union in the library and the use of volunteers were also associated (chi2(1, N=77)=4.77, P=0.029). When unions were present in the library, volunteers were less likely to be used. This research has implications for hospital library managers in the management of volunteers. Volunteers should not be viewed as a quick fix or as a long-term solution for a library's understaffing problem.

  7. Staffing the ISS Control Centers: Lessons Learned from Long-Duration Human Space Flight

    NASA Technical Reports Server (NTRS)

    Olsen, Carrie D.; Horvath, Timothy J.; Davis, Sally P.

    2006-01-01

    The International Space Station (ISS) has been in operation with a permanent human presence in space for over five years, and plans for continued operations stretch ten years into the future. Ground control and support operations are, likewise, a 15-year enterprise. This long-term, 24-hour per day, 7 day per week support has presented numerous challenges in the areas of ground crew training, initial and continued certification, and console staffing. The Mission Control Center in Houston, Texas and the Payload Operations Center in Huntsville, Alabama have both tackled these challenges, with similar, yet distinct, approaches. This paper describes the evolution of the staffing and training policies of both control centers in a chronological progression. The relative merits and shortcomings of the various policies employed are discussed and a summary of "lessons learned" is presented. Finally, recommendations are made as best practices for future long-term space missions.

  8. Synthesis of the project leadership staffing needs for successful development of alternative delivery programs.

    DOT National Transportation Integrated Search

    2017-08-01

    This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

  9. Effects of Domestic Violence Policies, Alcohol Taxes and Police Staffing Levels on Intimate Partner Homicide in Large U.S. Cities

    PubMed Central

    Zeoli, April M.; Webster, Daniel W.

    2010-01-01

    Objective To assess the relationships between intimate partner homicide (IPH) and public policies including police staffing levels in large U.S. cities. Design The research uses a multiple time-series design to examine the effects of statutes aimed at restricting access to firearms for perpetrators of domestic violence, allowing or mandating arrest for violators of domestic violence restraining orders (DVROs), beer excise taxes, and police staffing levels on IPH in 46 of the largest U.S. cities from 1979 to 2003. Both total IPH and IPH committed with a firearm are analyzed. Generalized estimating equations using a Poisson distribution are used to regress IPH on the policies and potential confounders. Results State statutes restricting those under DVROs from accessing firearms, and laws allowing the warrantless arrest of DVRO violators are associated with reductions in total and firearm IPH. Police staffing levels are also negatively associated with IPH and firearm IPH. There was no evidence that other policies to restrict firearm access to domestic violence offenders or alcohol taxes had a significant impact on IPH. Conclusions Reducing access to firearms for DVRO defendants, increasing police staffing levels and allowing the warrantless arrest of DVRO violators may reduce the city-level risk of IPH. Future research should evaluate factors that may mediate the effect of these laws and increased police staffing levels on IPH to determine if there are opportunities to increase their protective effect. Further research is needed on firearm law implementation to determine why the other tested laws were not found effective. PMID:20363814

  10. Staffing Preschools: Background Information.

    ERIC Educational Resources Information Center

    Katz, Lilian G.; Weir, Mary K.

    This report explores background variables related to preschool teaching, and emphasizes that statistics fluctuate in early childhood education. The increase for preprimary enrollment of 3- and 4-year-olds was 26 percent from 1966 to 1967. Accurate figures on preschool teaching personnel are not available, but a large proportion of Head Start…

  11. Increasing Institutional Research Productivity, Resources, and Staffing. AIR 1990 Annual Forum Paper.

    ERIC Educational Resources Information Center

    Clagett, Craig A.

    The argument is made that without proper staffing and support (a condition that occurs as financial pressures on higher education institutions increase) institutional research will not be able to prepare analyses of enough depth and sophistication to constitute a meaningful contribution to policy-making. An outline is provided as to how to…

  12. Innovative Staffing To Meet Technological Changes: A Case Study at Wake Forest University.

    ERIC Educational Resources Information Center

    Ganzert, Robin Roy; Watkins, Dawn Adele

    1997-01-01

    Examines the changes surrounding information technology as it relates to staffing issues at Wake Forest University (Winston-Salem, North Carolina). Highlights include: revision of organizational structure; decentralization of human resources processes; a survey of personnel attitudes; and trends for the human resources department. (AEF)

  13. Managing conflict in the workplace.

    PubMed

    Weygman, L

    1986-08-01

    Conflict is inevitable in the workplace. Mounting pressures to reduce staffing levels and improve productivity will almost certainly increase the level of conflict in the hospital setting in the coming months and years. The most effective managers will be those who can handle it constructively.

  14. Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface

    PubMed Central

    2010-01-01

    Background The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. Methods A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). Results The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). Conclusions As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized

  15. Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface.

    PubMed

    Simon, Michael; Hausner, Elke; Klaus, Susan F; Dunton, Nancy E

    2010-08-23

    The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized terminology (e.g. by consistent use of the

  16. Introduction to Personnel Management: Participants' Manual.

    ERIC Educational Resources Information Center

    Civil Service Commission, Denver, CO. Regional Training Center.

    This manual for the introductory Federal personnel management course covers: major personnel laws and sources of information; position classification (standards and task analysis); staffing and placement (competitive appointments, temporary appointments/promotions, recruitment, and noncompetitive actions); merit promotion; qualification standards;…

  17. Manager's handbook for software development, revision 1

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Methods and aids for the management of software development projects are presented. The recommendations are based on analyses and experiences of the Software Engineering Laboratory (SEL) with flight dynamics software development. The management aspects of the following subjects are described: organizing the project, producing a development plan, estimating costs, scheduling, staffing, preparing deliverable documents, using management tools, monitoring the project, conducting reviews, auditing, testing, and certifying.

  18. Reversing Course: The Troubled State of Academic Staffing and a Path Forward

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2008

    2008-01-01

    Over the last generation, the instructional staffing system in American higher education has experienced a significant reduction in the proportion of jobs for full-time tenured and tenure-track faculty members and a dramatic growth in fixed-term full- and part-time instructional jobs without tenure. About 70 percent of the people teaching in…

  19. The daily relationships between staffing, safety perceptions and personality in hospital nursing: A longitudinal on-line diary study.

    PubMed

    Louch, Gemma; O'Hara, Jane; Gardner, Peter; O'Connor, Daryl B

    2016-07-01

    The association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. To further our understanding of these associations, this paper takes a within-person approach to examine nurses' daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. We recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three-five shifts which collected information on perceptions of staffing, patient-nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. On days when lower patient-nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p=.011) and more favourable perceptions of patient safety (p=<.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p=<.001), more favourable perceptions of patient safety (p=<.001) and experienced less workplace cognitive failure (p=<.001). Conscientiousness and emotional stability emerged

  20. An information system to improve financial management, resource allocation and activity planning: evaluation results.

    PubMed

    Ruland, C M; Ravn, I H

    2001-01-01

    An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

  1. Organizing and Managing Small Rural Colleges: More Bang for the Buck.

    ERIC Educational Resources Information Center

    McCarter, W. Ronald; Barnes, Edwin L.

    While small rural colleges have much the same goals as larger institutions, they have fewer resources with which to work, and therefore their management problems are unique. In the areas of staffing, time management, staff development, and recruitment and promotion, the small college can increase management effectiveness. Despite increasing…

  2. Report: Congressionally Requested Report on EPA Staffing Levels and Total Costs for EPA Facilities

    EPA Pesticide Factsheets

    Report #09-P-0080, January 14, 2009. Additional information on the staffing levels, rental/lease fees, and utility and security costs for all of the EPA facilities and/or locations where EPA incurs costs associated with its employees.

  3. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  4. The Missing Link--Manpower Staffing Standards and the Budget Process

    DTIC Science & Technology

    1986-04-01

    used to- develop the combat and ,-ombat support forces dc’cumented in Tables of Organizaticn and Equipment (TOE). A MS-3 standard is essentially an...candidates for standards develo pment. Where this e., ists and where it i not ecnomically reasonable to justi fy the development effort, standards are not...sector have the special trust of the taxpayers, and, as such, must ensure that staffing cf these functions is minimum essential . The functio n of

  5. Physical Attacks: An Analysis of Teacher Characteristics Using the Schools and Staffing Survey

    ERIC Educational Resources Information Center

    Williams, Thomas O., Jr.; Ernst, Jeremy V.

    2016-01-01

    This study investigated physical attacks as reported by public school teachers on the most recent Schools and Staffing Survey (SASS) from the National Center for Education Statistics administered by the Institute of Educational Sciences. For this study, characteristics of teachers who responded affirmatively to having been physically attacked in…

  6. Successful Implementation of Six Sigma to Schedule Student Staffing for Circulation Service Desks

    ERIC Educational Resources Information Center

    Jankowski, Janiece

    2013-01-01

    In fall of 2011 the University at Buffalo Libraries circulation department undertook Six Sigma training for the purpose of overhauling its student scheduling process. The department was able to mitigate significant staffing budgetary reductions and resource reallocations and to overcome the unique challenges of scheduling student labor for a…

  7. Comprehensive evaluation of contemporary assisted reproduction technology laboratory operations to determine staffing levels that promote patient safety and quality care.

    PubMed

    Alikani, Mina; Go, Kathryn J; McCaffrey, Caroline; McCulloh, David H

    2014-11-01

    To consider how staffing requirements have changed with evolving and increasingly more complex assisted reproduction technology (ART) laboratory practice. Analysis by four laboratory directors from three different ART programs of the level of complexity and time requirements for contemporary ART laboratory activities to determine adequate staffing levels. University-based and private ART programs. None. None. Human resource requirements for ART procedures. Both complexity and time required for completion of a contemporary ART cycle have increased significantly compared with the same requirements for the "traditional cycle" of the past. The latter required roughly 9 personnel hours, but a contemporary cycle can require up to 20 hours for completion. Consistent with this increase, a quantitative analysis shows that the number of embryologists required for safe and efficient operation of the ART laboratory has also increased. This number depends on not only the volume but also the types of procedures performed: the higher the number of complex procedures, the more personnel required. An interactive Personnel Calculator is introduced that can help determine staffing needs. The increased complexity of the contemporary ART laboratory requires a new look at the allocation of human resources. Our work provides laboratory directors with a practical, individualized tool to determine their staffing requirements with a view to increasing the safety and efficiency of operations. The work could serve as the basis for revision of the 2008 American Society for Reproductive Medicine (ASRM) staffing guidelines. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Using volunteers in Ontario hospital libraries: views of library managers*

    PubMed Central

    McDiarmid, Mary; Auster, Ethel

    2005-01-01

    Background: Volunteers have been a resource for all types of libraries for many years. Little research has been done to describe the attitudes librarians have toward library volunteers. More specifically, the attitudes of hospital librarians toward volunteers have never been studied. Objective: The objective was to explore and describe the extent of volunteer use and to determine library managers' attitudes toward volunteers. Design, Setting, and Participants: An anonymous, self-report 38-item questionnaire was mailed to the target population of 89 hospital library managers in Ontario. Seventy-nine useable questionnaires were analyzed from an adjusted sample of 86 eligible respondents, resulting in a response rate of 92%. SPSS 11.5 was used to analyze the data. Findings: The data revealed the attitudes of managers using volunteers did not differ significantly from the attitudes of managers not using volunteers. The findings showed that a majority of managers did not believe their libraries were adequately staffed with paid employees. Sufficient evidence was found of an association between a manager's belief in the adequacy of staffing in the library and the use of volunteers in the library (χ2(1, N = 76) = 4.11, P = 0.043). Specifically, volunteers were more likely to be used by managers who did not believe their libraries were adequately staffed. The presence of a union in the library and the use of volunteers were also associated (χ2(1, N = 77) = 4.77, P = 0.029). When unions were present in the library, volunteers were less likely to be used. Implications: This research has implications for hospital library managers in the management of volunteers. Volunteers should not be viewed as a quick fix or as a long-term solution for a library's understaffing problem. PMID:15858629

  9. [The new methods to define the staffing requirements for doctors,
    nurses and nurses aides: an example of their implementation in an Italian hospital].

    PubMed

    Laquintana, Dario; Pazzaglia, Silvia; Demarchi, Antonia

    2017-01-01

    . 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. To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. 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. 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. 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.

  10. Resource Input, Service Process and Resident Activity Indicators in a Welsh National Random Sample of Staffed Housing Services for People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Felce, David; Perry, Jonathan

    2004-01-01

    Background: The aims were to: (i) explore the association between age and size of setting and staffing per resident; and (ii) report resident and setting characteristics, and indicators of service process and resident activity for a national random sample of staffed housing provision. Methods: Sixty settings were selected randomly from those…

  11. Nurse Staffing at Methodist Heathcare Ministries: Factors Influencing Recruiting and Retention

    DTIC Science & Technology

    2007-04-01

    a provider’s personality strongly influences their satisfaction with the working environment. The study recognized some critical factors for working ... with us today?" (Smith, 2005, p. 56). Nurse Staffing at 22 After the organization has addressed its culture, it can then begin transforming work ...most important to the employees working at MHM were identified. These factors can be used , in conjunction with the literature, to tailor applicable

  12. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

    PubMed

    Berg Jansson, Anna; Engström, Åsa

    2017-08-01

    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. The Benefit Implications of Recent Trends in Flexible Staffing Arrangements. Staff Working Paper.

    ERIC Educational Resources Information Center

    Houseman, Susan N.

    Workers in flexible staffing arrangementsincluding temporary agency, direct-hire temporary, on-call, and contract workersare much less likely than regular, direct-hire employees to be covered by laws mandating or regulating workplace benefits. They are also much less likely to receive pension, health insurance, and other benefits on the job.…

  14. Staffing Trends of Disability Care Institutions in Taiwan during the Period 2002-2007

    ERIC Educational Resources Information Center

    Fang, Wen-Hui; Yen, Chia-Feng; Wu, Jia-Ling; Lin, Lan-Ping; Kuo, Fang-Yu; Chou, Yu-Ching; Lin, Jin-Ding

    2009-01-01

    The objectives of this study were to examine trends related to the staffing of disability welfare institutions caring for people with disabilities in Taiwan. Nationwide data from the 2002 to 2007 "Service Manpower in Disability Welfare Institutions" report, which are derived mainly from the Department of Statistics, Ministry of the…

  15. Managing Academic Libraries with Fewer Resources.

    ERIC Educational Resources Information Center

    Riggs, Donald E.

    1992-01-01

    A discussion of academic library management during retrenchment looks at a variety of issues, including staffing needs in the labor-intensive library environment, acquisitions budgeting, interlibrary cooperation (ownership vs. access to resources), entrepreneurship and strategic planning for problem solving, and use of total quality management…

  16. An Examination of Current Navy Medical Professionals Management Oriented Service Short Courses

    DTIC Science & Technology

    1993-06-17

    diversity in the workplace .83 52. Building a climate that promotes ethical...staffing needs 50. Managing labor relations(union negotiations, grievances, etc.) 51. Managing multi-cultural diversity in the workplace 1.33 52. Building...needs 1.25 50. Managing labor relationsfunion negotiations, grievances. etc.) 51. Managing multi-cultural diversity in the workplace 52. Building

  17. Management Education in Public Health: Further Considerations

    PubMed Central

    Darr, Kurt J.

    2015-01-01

    Knowing and applying the basic management functions of planning, organizing, staffing, directing, and controlling, as well as their permutations and combinations, are vital to effective delivery of public health services. Presently, graduate programs that prepare public health professionals neither emphasize teaching management theory, nor its application. This deficit puts those who become managers in public health and those they serve at a distinct disadvantage. This deficit can be remedied by enhanced teaching of management subjects PMID:26673475

  18. Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

    PubMed

    Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

    2015-11-06

    Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in

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

    PubMed

    Patrician, Patricia A; McCarthy, Mary S; Swiger, Pauline; Raju, Dheeraj; Breckenridge-Sproat, Sara; Su, Xiaogang; Randall, Kelly H; Loan, Lori A

    2017-04-01

    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. © 2016 Wiley Periodicals, Inc.

  20. District nursing renascent as Wales adopts safe staffing levels.

    PubMed

    Labourne, Paul

    2018-05-02

    This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.

  1. Physician staffing pattern in intensive care units: Have we cracked the code?

    PubMed Central

    Juneja, Deven; Nasa, Prashant; Singh, Omender

    2012-01-01

    Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units (ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a “turf” war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffing may be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients. PMID:24701396

  2. Expanded resources through utilization of a primary care giver extracorporeal membrane oxygenation model.

    PubMed

    Freeman, Regi; Nault, Chrissy; Mowry, Jole'; Baldridge, Paula

    2012-01-01

    Extracorporeal membrane oxygenation (ECMO) is a long-term extracorporeal support for critically ill patients with life-threatening compromises in cardiac and/or respiratory function. The unpredictability of ECMO resources for a large pediatric and adult population prompted a need for the ability to respond to significant fluctuations in the volume of patients on ECMO. Through multidisciplinary collaboration, the Primary Care Giver (PCG) ECMO Staffing Model was developed to accommodate unpredictable fluctuations in ECMO activity and to maintain flexibility and fiscal responsibility in turbulent economic times. Advancements in extracorporeal technology supported the opportunity to develop a safe and extended staffing model for ECMO. Combining the use of a centrifugal pump system with specialized and experienced cardiovascular intensive care nurses and the ECMO specialist team provided a milieu for education and training to support the new staffing model. The PCG ECMO model provides a safe, flexible, and fiscally responsible staffing model for variable ECMO activity.

  3. An observational study of the relationship between Capacity for Care as an animal shelter management model and cat health, adoption and death in three animal shelters.

    PubMed

    Karsten, C L; Wagner, D C; Kass, P H; Hurley, K F

    2017-09-01

    Animal shelters struggle to function at their 'right size' in terms of physical, staffing and outcome capacity, especially with seasonal fluctuations in cat intake. To address this, a Capacity for Care (C4C) management model was devised to balance health and welfare requirements of all animals while maintaining or improving goals for positive outcomes, such as adoption or transfer. In this observational study of three shelters, applying the C4C management system gave each organization an optimal average daily shelter cat population target (to be achieved through proactive length of stay management) and helped each shelter to increase the size of their feline housing units. Pre- and post-C4C implementation data were evaluated to determine impact on average monthly isolation ward populations and cat outcomes such as adoptions and shelter deaths (euthanasia/died). Improved outcomes including increased adoption probability, decreased shelter death probability and fewer cats requiring infectious disease isolation were seen after C4C institution. Results suggest that implementation of this management model could help other shelters achieve similar results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Reference Transactions Analysis: The Cost-Effectiveness of Staffing a Traditional Academic Reference Desk

    ERIC Educational Resources Information Center

    Ryan, Susan M.

    2008-01-01

    This study categorizes 6959 reference desk transactions to determine how many of the queries require the attention of a librarian. Results indicate that 89% could likely be answered by non-librarians. From the results of this and other studies, the author explores the cost-effectiveness of staffing a traditional reference desk with librarians.…

  5. Teacher Questionnaire: Schools and Staffing Survey. 2011-12 School Year. SASS-4A

    ERIC Educational Resources Information Center

    National Center for Education Statistics, 2012

    2012-01-01

    The Schools and Staffing Survey (SASS) is a system of related questionnaires that provide descriptive data on the context of elementary and secondary education and policymakers a variety of statistics on the condition of education in the United States. The SASS system covers a wide range of topics from teacher demand, teacher and principal…

  6. Coping strategies to manage stress related to vision loss and fluctuations in retinitis pigmentosa

    PubMed Central

    Bittner, Ava K.; Edwards, Lori; George, Maureen

    2010-01-01

    Background Vision loss in retinitis pigmentosa (RP) is a slowly progressive and inexorable threat to patients’ independence. It is not surprising that RP patients, many of whom are young when diagnosed, are at high risk for stress related to their vision loss. To address these issues, eye care providers need to be aware of what coping strategies RP patients use to successfully manage their vision loss. Methods We held focus groups with eight legally blind RP patients to help us better understand how they cope with the stress that is generated from their progressive vision loss and fluctuations in vision. Focus group sessions were audiotaped and resulting notes were coded using conventional qualitative analytic techniques. Results Two themes were identified: 1) “kicking and screaming” captured the ways in which RP patients fight to maintain their independence in the face of worsening vision; and 2) “there are so many worse things” describes how RP patients keep their vision loss in perspective. These RP patients demonstrated high levels of resiliency. In particular, they often used humor as a coping mechanism. Conclusions Understanding the ways in which RP patients manage their gradual, impending vision loss may lead to improved quality of care for this patient population. PMID:20591747

  7. Community health centers at the crossroads: growth and staffing needs.

    PubMed

    Proser, Michelle; Bysshe, Tyler; Weaver, Donald; Yee, Ronald

    2015-04-01

    In response to increased demand for primary care services under the Affordable Care Act, the national network of community health centers (CHCs) will play an increasingly prominent role. CHCs have a broad staffing model that includes extensive use of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs). Between 2007 and 2012, the number of PAs, NPs, and CNMs at CHCs increased by 61%, compared with 31% for physicians. However, several policy and payment issues jeopardize CHCs' ability to expand their workforce and meet the current and rising demand for care.

  8. Hospital nurse staffing and public health emergency preparedness: implications for policy.

    PubMed

    McHugh, Matthew D

    2010-01-01

    Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation's emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage.

  9. Implications of staff 'churn' for nurse managers, staff, and patients.

    PubMed

    Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine

    2009-01-01

    In this article, the term "churn" is used not only because of the degree of change to staffing, but also because some of the reasons for staff movement are not classified as voluntary turnover. The difficulties for the nurse managing a unit with the degree of "churn" should not be under-estimated. Changes to skill mix and the proportions of full-time, agency, and temporary staff present challenges in providing clinical leadership, scheduling staff, performance management, and supervision. Perhaps more importantly, it is likely that there is an impact on the continuity of care provided in the absence of continuity of staffing. A greater understanding of the human and financial costs and consequences, and a willingness to change established practices at the institutional and ward level, are needed.

  10. Outcomes and Costs of Community Living: Semi-Independent Living and Fully Staffed Group Homes

    ERIC Educational Resources Information Center

    Felce, David; Perry, Jonathan; Romeo, Renee; Robertson, Janet; Meek, Andrea; Emerson, Eric; Knapp, Martin

    2008-01-01

    In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes,…

  11. Washington State Board for Community and Technical Colleges Enrollment and Staffing Report, Fall 2014

    ERIC Educational Resources Information Center

    Washington State Board for Community and Technical Colleges, 2014

    2014-01-01

    The "Fall Enrollment and Staffing Report 2014" provides a snapshot of enrollments in community and technical colleges during fall quarter 2014. The report addresses the questions most commonly raised regarding the community and technical colleges in Washington. The primary source of information for this document is the State Board for…

  12. Washington State Board for Community and Technical Colleges Enrollment and Staffing Report, Fall 2013

    ERIC Educational Resources Information Center

    Washington State Board for Community and Technical Colleges, 2013

    2013-01-01

    The "Fall Enrollment and Staffing Report 2013" provides a snapshot of enrollments in community and technical colleges during fall quarter 2013. The report addresses the questions most commonly raised regarding the community and technical colleges in Washington. The primary source of information for this document is the State Board for…

  13. Report on Staffing and Salaries, Fall 1987. California Community Colleges Report Number 88-6.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    This report presents fall 1987 demographic, staffing, salary, and workload information on California community college employees, based on data provided by 68 of the 70 districts in the state. First, tables present the total number of district employees by: primary occupational activity; the number of full-time equivalent (FTE) employees by…

  14. Schools and Staffing Survey (SASS) Data File User's Manual, 1999-2000. NCES 2004-303

    ERIC Educational Resources Information Center

    Tourkin, Steven C.; Pugh, Kathleen Wise; Fondelier, Sharon E.; Parmer, Randall J.; Cole, Cornette; Jackson, Betty; Warner, Toni; Weant, Gayle; Walter, Elizabeth

    2004-01-01

    The Schools and Staffing Survey (SASS) is conducted by the National Center for Education Statistics (NCES) on behalf of the United States Department of Education in order to collect extensive data on American public and private elementary and secondary schools. SASS provides data on the characteristics and qualifications of teachers and…

  15. Battle Cry of the Web Managers.

    ERIC Educational Resources Information Center

    Cornforth, Suzanne R.

    1998-01-01

    College and university Web site managers are offered advice for creative funding and staffing, including how to determine actual human, equipment, and financial resource needs; six ways to break out of the conventional funding paradigm (using existing resources well, using others' money, advertising, priority shifts, shared resources, and in-kind…

  16. Hospital Nurse Staffing and Public Health Emergency Preparedness: Implications for Policy

    PubMed Central

    McHugh, Matthew D.

    2010-01-01

    Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation’s emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage. PMID:20840714

  17. Mercury and water level fluctuations in lakes of northern Minnesota

    USGS Publications Warehouse

    Larson, James H.; Maki, Ryan P; Christensen, Victoria G.; Sandheinrich, Mark B.; LeDuc, Jaime F.; Kissane, Claire; Knights, Brent C.

    2017-01-01

    Large lake ecosystems support a variety of ecosystem services in surrounding communities, including recreational and commercial fishing. However, many northern temperate fisheries are contaminated by mercury. Annual variation in mercury accumulation in fish has previously been linked to water level (WL) fluctuations, opening the possibility of regulating water levels in a manner that minimizes or reduces mercury contamination in fisheries. Here, we compiled a long-term dataset (1997-2015) of mercury content in young-of-year Yellow Perch (Perca flavescens) from six lakes on the border between the U.S. and Canada and examined whether mercury content appeared to be related to several metrics of WL fluctuation (e.g., spring WL rise, annual maximum WL, and year-to-year change in maximum WL). Using simple correlation analysis, several WL metrics appear to be strongly correlated to Yellow Perch mercury content, although the strength of these correlations varies by lake. We also used many WL metrics, water quality measurements, temperature and annual deposition data to build predictive models using partial least squared regression (PLSR) analysis for each lake. These PLSR models showed some variation among lakes, but also supported strong associations between WL fluctuations and annual variation in Yellow Perch mercury content. The study lakes underwent a modest change in WL management in 2000, when winter WL minimums were increased by about 1 m in five of the six study lakes. Using the PLSR models, we estimated how this change in WL management would have affected Yellow Perch mercury content. For four of the study lakes, the change in WL management that occurred in 2000 likely reduced Yellow Perch mercury content, relative to the previous WL management regime.

  18. The role of physician staffing of helicopter emergency medical services in prehospital trauma response.

    PubMed

    Garner, Alan A

    2004-08-01

    The crewing of Helicopter Emergency Medical Service (HEMS) for scene response to trauma patients is generally considered to be controversial, particularly regarding the role of physicians. This is reflected in HEMS in Australia with some services utilizing physician crewing for all prehospital missions. Others however, use physicians for selected missions only whilst others do not use physicians at all. This review seeks to determine whether the literature supports using physicians in addition to paramedics in HEMS teams for prehospital trauma care. Studies were excluded if they compared physician teams with basic life support teams (BLS) teams rather than paramedics. Ambulance officers were considered to be paramedics where they were able to administer intravenous fluids and use a method of airway management beyond bag-valve-mask ventilation. Studies were excluded if the skill set of the ambulance team was not defined, the level of staffing of the helicopter service was not stated, team composition varied without reporting outcomes for each team type, patient outcome data were not reported, or the majority of the transports were interhospital rather than prehospital transports.

  19. 10 CFR 719.12 - What information must be included in the Legal Management Plan?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false What information must be included in the Legal Management Plan? 719.12 Section 719.12 Energy DEPARTMENT OF ENERGY CONTRACTOR LEGAL MANAGEMENT REQUIREMENTS Legal Management Plan, Staffing and Resource Plan and Annual Legal Budget § 719.12 What information must be...

  20. 76 FR 73683 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-29

    ..., Inc., Fort Smith, AR; Amended Certification Regarding Eligibility To Apply for Worker Adjustment... Career Solutions TEC Staffing, Fort Smith, Arkansas. The workers are engaged in the production of...., Prodriver, and Arkansas Warehouse, Inc. were employed on-site at the Fort Smith, Arkansas location of...

  1. 76 FR 72978 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ..., TEK Systems, Penske Logistics, Eurest, and Canteen, Fort Smith, AR; Amended Certification Regarding... Corporation, including on-site leased workers from Career Solutions TEC Staffing, Fort Smith, Arkansas. The... Corporation, TEK Systems, Penske Logistics, Eurest, and Canteen were employed on-site at the Fort Smith...

  2. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    ERIC Educational Resources Information Center

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  3. Library/Media Centers in U.S. Public Schools: Growth, Staffing, and Resources. Executive Summary

    ERIC Educational Resources Information Center

    Tuck, Kathy D.; Holmes, Dwight R.

    2016-01-01

    This study analyzes data collected between 2000 and 2013 from the annual National Center for Education Statistics (NCES) Common Core of Data (CCD) Local Education Agency (School District) Universe Survey; the NCES Schools and Staffing Survey (SASS); and the U.S. Census Bureau Small Area Income and Poverty Estimates Survey (SAIPE). The findings…

  4. Diagnostic Grouping among Adults with Intellectual Disabilities and Autistic Spectrum Disorders in Staffed Housing

    ERIC Educational Resources Information Center

    Felce, D.; Perry, J.

    2012-01-01

    Background: There is little evidence to guide the commissioning of residential provision for adults with autistic spectrum disorder (ASD) in the UK. We aim to explore the degree and impact of diagnostic congregation among adults with intellectual disabilities (ID) and ASD living in staffed housing. Methods: One hundred and fifty-seven adults with…

  5. 1980-1981 Comparative Costs and Staffing Report for Physical Plants of Colleges and Universities.

    ERIC Educational Resources Information Center

    Association of Physical Plant Administrators of Universities and Colleges, Washington, DC.

    Comparative costs of plant maintenance and operations functions, including staffing costs, for higher education institutions are presented for 1980-1981. The objective of the survey data is to promote comparisons of unit costs per gross square foot of the functions classified as maintenance and operations of plant, the number of full-time…

  6. Brownian Motion with Active Fluctuations

    NASA Astrophysics Data System (ADS)

    Romanczuk, Pawel; Schimansky-Geier, Lutz

    2011-06-01

    We study the effect of different types of fluctuation on the motion of self-propelled particles in two spatial dimensions. We distinguish between passive and active fluctuations. Passive fluctuations (e.g., thermal fluctuations) are independent of the orientation of the particle. In contrast, active ones point parallel or perpendicular to the time dependent orientation of the particle. We derive analytical expressions for the speed and velocity probability density for a generic model of active Brownian particles, which yields an increased probability of low speeds in the presence of active fluctuations in comparison to the case of purely passive fluctuations. As a consequence, we predict sharply peaked Cartesian velocity probability densities at the origin. Finally, we show that such a behavior may also occur in non-Gaussian active fluctuations and discuss briefly correlations of the fluctuating stochastic forces.

  7. Improving traffic signal management and operations : a basic service model.

    DOT National Transportation Integrated Search

    2009-12-01

    This report provides a guide for achieving a basic service model for traffic signal management and : operations. The basic service model is based on simply stated and defensible operational objectives : that consider the staffing level, expertise and...

  8. Social Problem Solving in Staffed Community Homes among Individuals with Intellectual Disabilities and Their Staff

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Miller, Arlene Michaels; Fogg, Louis

    2014-01-01

    Individuals with intellectual disabilities (ID) increasingly live with other individuals with ID in small community homes staffed by paraprofessionals where aggressive/challenging (problem) behaviors occur more frequently then among individuals with ID living with their families. Evidence suggests that individuals with ID are more susceptible to…

  9. 76 FR 10394 - Ohio Decorative Products, Inc., Including On-Site Leased Workers From Custom Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-24

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,890] Ohio Decorative Products, Inc., Including On-Site Leased Workers From Custom Staffing, Spencerville, OH; Amended Certification... Act of 1974, as amended (``Act''), 19 U.S.C. 2273, the Department of Labor issued a Certification of...

  10. Qualitative and Quantitative Management Tools Used by Financial Officers in Public Research Universities

    ERIC Educational Resources Information Center

    Trexler, Grant Lewis

    2012-01-01

    This dissertation set out to identify effective qualitative and quantitative management tools used by financial officers (CFOs) in carrying out their management functions of planning, decision making, organizing, staffing, communicating, motivating, leading and controlling at a public research university. In addition, impediments to the use of…

  11. Implementation Differences of Two Staffing Models in the German Home Visiting Program "Pro Kind"

    ERIC Educational Resources Information Center

    Brand, Tilman; Jungmann, Tanja

    2012-01-01

    As different competencies or professional backgrounds may affect the quality of program implementation, staffing is a critical issue in home visiting. In this study, N = 430 women received home visits delivered either by a tandem of a midwife and a social worker or by only one home visitor (primarily midwives, continuous model). The groups were…

  12. Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations.

    PubMed

    Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile

    2015-04-01

    The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Alternative arrangements for the delivery of eye care services within staff model managed care organizations.

    PubMed

    Soroka, Mort; Reis, Lesley; Krumholz, David; Krasner, Mel; Portello, Joan

    2003-11-01

    Eye care services, though accounting for only a small fraction of healthcare costs, encompass a unique spectrum of professional staffing options that can enhance efficiency and decrease costs within staff model managed care organizations. This study was designed to describe and assess alternative staffing arrangements and cost implications for the delivery of eye care services by optometrists, ophthalmologists, and primary care physicians within staff model managed care organizations. The clinical records of individual patients--rather than administrative and billing files--at three managed care organizations are the principal source of information. Clinical auditors extracted data on ambulatory eye care services provided for conjunctivitis, corneal abrasion/erosion, cataract, diabetic retinopathy, glaucoma, and macular degeneration. Our findings document the substantial role optometrists play in the delivery of eye care, whether they provide the care independently or in collaboration with an ophthalmologist. The levels of remuneration for optometrists are roughly one third to one half the annual rate for ophthalmologists. Staffing arrangements that use optometrists to the full extent of their professional training can provide significant cost savings. The cost-effectiveness of using the services of optometrists capable of delivering high-quality eye care can be demonstrated. Potential cost savings for staff model managed care organizations may accrue if the roles, functions, and availability of eye providers are adjusted.

  14. Influence of thermal fluctuations on ligament break-up: a fluctuating lattice Boltzmann study

    NASA Astrophysics Data System (ADS)

    Xue, Xiao; Biferale, Luca; Sbragaglia, Mauro; Toschi, Federico

    2017-11-01

    Thermal fluctuations are essential ingredients in a nanoscale system, driving Brownian motion of particles and capillary waves at non-ideal interfaces. Here we study the influence of thermal fluctuations on the breakup of liquid ligaments at the nanoscale. We offer quantitative characterization of the effects of thermal fluctuations on the Plateau-Rayleigh mechanism that drives the breakup process of ligaments. Due to thermal fluctuations, the droplet sizes after break-up need to be analyzed in terms of their distribution over an ensemble made of repeated experiments. To this aim, we make use of numerical simulations based on the fluctuating lattice Boltzmann method (FLBM) for multicomponent mixtures. The method allows an accurate and efficient simulation of the fluctuating hydrodynamics equations of a binary mixture, where both stochastic viscous stresses and diffusion fluxes are introduced. This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant Agreement No 642069.

  15. Running Head: Evaluation of Contract Versus VA-Staffed CBOCs. Evaluating Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCs) Using Patient Satisfaction and Access Measures in the Veterans Health Administration

    DTIC Science & Technology

    2009-06-01

    Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCS) Using Patient Satisfaction and Access Measures in the Veterans Health ...Administration 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Belote, Janna, M., Civilian - Veterans Health Administration 5d. PROJECT NUMBER 5e...TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Central Arkansas Veterans Healthcare System 4300 West 7th

  16. Variation Across U.S. Assisted Living Facilities: Admissions, Resident Care Needs, and Staffing.

    PubMed

    Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum

    2017-01-01

    Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight

  17. Professional Staffing Levels and Fourth-Grade Student Research in Rural Schools with High-Poverty Levels

    ERIC Educational Resources Information Center

    Krueger, Karla Steege; Donham, Jean

    2013-01-01

    Rural schools in high-poverty areas are often understaffed. This descriptive phenomenological study examined fourth-grade state research projects in high-poverty rural Iowa schools to reveal the influence of school librarians' staffing levels on student learning of research skills. To determine evidence of students' critical literacy, ethical use…

  18. Library/Media Centers in U.S. Public Schools: Growth, Staffing, and Resources. Full Report

    ERIC Educational Resources Information Center

    Tuck, Kathy D.; Holmes, Dwight R.

    2016-01-01

    At the request of New Business Item: 89 (NBI: 89) adopted at the 2015 NEA Representative Assembly, this study examines the extent to which students have access to public school library/media centers with qualified staff and up-to-date resources. The study explores trends in library/media center openings and closings as well as staffing patterns…

  19. Eccentricity fluctuations are not the only source of elliptic flow fluctuations in a multiphase transport model

    NASA Astrophysics Data System (ADS)

    Xiao, Kai; Liu, Feng; Wang, Fu-Qiang

    2017-09-01

    Sources of event-by-event elliptic flow fluctuations in relativistic heavy-ion collisions are investigated in a multiphase parton transport model (AMPT). Besides the well-known initial eccentricity fluctuations, several other sources of elliptic flow dynamical fluctuations are identified. One is fluctuations in initial parton configurations at a given eccentricity. Configuration fluctuations are found to be as important as eccentricity fluctuations in elliptic flow development. A second is quantum fluctuations in parton-parton interactions during system evolution. A third is fluctuations caused by hadronization and final-state hadronic scatterings. The magnitudes of these fluctuations are investigated relative to the eccentricity fluctuations and the average elliptic flow magnitude. The fluctuations from the latter two sources are found to be negative. The results may have important implications for the interpretation of elliptic flow data. Supported by MOST, China, under 973 Grant 2015CB856901, National Natural Science Foundation of China (11521064, 11547143, 11228513), U.S. Department of Energy (DE-FG02-88ER40412), Fundamental Research Funds for the Central Universities, South-Central University for Nationalities (CZQ15001) and Excellent Doctorial Dissertation Cultivation Grant from Central China Normal University (2013YBZD18)

  20. Perceptions of Risk and Safety in the ICU: A Qualitative Study of Cognitive Processes Relating to Staffing*

    PubMed Central

    D’Lima, Danielle M.; Brett, Stephen J.

    2018-01-01

    Objectives: The aims of this study were to 1) examine individual professionals’ perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Design: Qualitative case study methodology with nurses, doctors, and physiotherapists. Setting: Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Subjects: Forty-four ICU team members of diverse professional backgrounds and seniority. Interventions: None. Main Results: Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an “A” team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a “dynamic balance” influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals’ risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. Conclusions: This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals’ cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals’ perfectionist or pragmatic approach. Perfectionists’ team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived “A” team but diminished by interdisciplinary tensions. Third, counter intuitively, higher “situational” awareness for some individuals increased their stress and anxiety. Finally, our

  1. Perceptions of Risk and Safety in the ICU: A Qualitative Study of Cognitive Processes Relating to Staffing.

    PubMed

    D'Lima, Danielle M; Murray, Eleanor J; Brett, Stephen J

    2018-01-01

    The aims of this study were to 1) examine individual professionals' perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Qualitative case study methodology with nurses, doctors, and physiotherapists. Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Forty-four ICU team members of diverse professional backgrounds and seniority. None. Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an "A" team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a "dynamic balance" influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals' risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals' cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals' perfectionist or pragmatic approach. Perfectionists' team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived "A" team but diminished by interdisciplinary tensions. Third, counter intuitively, higher "situational" awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize

  2. Determinants of hospital fall rate trajectory groups: A longitudinal assessment of nurse staffing and organizational characteristics

    PubMed Central

    Everhart, Damian; Schumacher, Jessica R.; Duncan, R. Paul; Hall, Allyson G.; Neff, Donna F.; Shorr, Ronald I.

    2014-01-01

    Background Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. Purpose The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. Methodology/Approach We conducted a 54-month (July 2006–December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators® (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. Findings A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the “consistently high” fall rate group. Practice Implications Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which “best practices

  3. 75 FR 43556 - Badger Meter, Inc., Including On-Site Leased Workers From Sourcepoint Staffing, Seek, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-26

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,666] Badger Meter, Inc... of Badger Meter, Inc., including on-site leased workers from Sourcepoint Staffing, Milwaukee..., Wisconsin location of Badger Meter, Inc. The Department has determined that these workers were sufficiently...

  4. 75 FR 45159 - Stanadyne Corporation, Including On-Site Leased Workers From Infini-Staff, Staffing Now and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ..., Including On-Site Leased Workers From Infini-Staff, Staffing Now and Apollo Professional Solutions, Inc... shows that workers leased from Apollo Professional Solutions were employed on-site at the Windsor..., the Department is amending this certification to include workers leased from Apollo Professional...

  5. Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence.

    PubMed

    Lepping, P; Steinert, T; Needham, I; Abderhalden, C; Flammer, E; Schmid, P

    2009-09-01

    Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.

  6. U.S. Catholic Elementary and Secondary Schools 2016-2017. The Annual Statistical Report on Schools, Enrollment and Staffing

    ERIC Educational Resources Information Center

    McDonald, Dale; Schultz, Margaret

    2017-01-01

    The latest edition highlights information about schools, enrollment and staffing patterns for Catholic elementary and secondary schools. [For "U.S. Catholic Elementary and Secondary Schools 2015-2016," see ED574513.

  7. Mechanical energy fluctuations in granular chains: the possibility of rogue fluctuations or waves.

    PubMed

    Han, Ding; Westley, Matthew; Sen, Surajit

    2014-09-01

    The existence of rogue or freak waves in the ocean has been known for some time. They have been reported in the context of optical lattices and the financial market. We ask whether such waves are generic to late time behavior in nonlinear systems. In that vein, we examine the dynamics of an alignment of spherical elastic beads held within fixed, rigid walls at zero precompression when they are subjected to sufficiently rich initial conditions. Here we define such waves generically as unusually large energy fluctuations that sustain for short periods of time. Our simulations suggest that such unusually large fluctuations ("hot spots") and occasional series of such fluctuations through space and time ("rogue fluctuations") are likely to exist in the late time dynamics of the granular chain system at zero dissipation. We show that while hot spots are common in late time evolution, rogue fluctuations are seen in purely nonlinear systems (i.e., no precompression) at late enough times. We next show that the number of such fluctuations grows exponentially with increasing nonlinearity whereas rogue fluctuations decrease superexponentially with increasing precompression. Dissipation-free granular alignment systems may be possible to realize as integrated circuits and hence our observations may potentially be testable in the laboratory.

  8. Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing.

    PubMed

    Ward, Nicholas S; Afessa, Bekele; Kleinpell, Ruth; Tisherman, Samuel; Ries, Michael; Howell, Michael; Halpern, Neil; Kahn, Jeremy

    2013-02-01

    Increases in the number, size, and occupancy rates of ICUs have not been accompanied by a commensurate growth in the number of critical care physicians leading to a workforce shortage. Due to concern that understaffing may exist, the Society of Critical Care Medicine created a taskforce to generate guidelines on maximum intensivists/patient ratios. A multidisciplinary taskforce conducted a review of published literature on intensivist staffing and related topics, a survey of pulmonary/Critical Care physicians, and held an expert roundtable conference. A statement was generated and revised by the taskforce members using an iterative consensus process and submitted for review to the leadership council of the Society of Critical Care Medicine. For the purposes of this statement, the taskforce limited its recommendations to ICUs that use a "closed" model where the intensivists control triage and patient care. The taskforce concluded that while advocating a specific maximum number of patients cared for is unrealistic, an approach that uses the following principles is essential: 1) proper staffing impacts patient care; 2) large caseloads should not preclude rounding in a timely fashion; 3) staffing decisions should factor surge capacity and nondirect patient care activities; 4) institutions should regularly reassess their staffing; 5) high staff turnover or decreases in quality-of-care indicators in an ICU may be markers of overload; 6) telemedicine, advanced practice professionals, or nonintensivist medical staff may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous methods; 7) in teaching institutions, feedback from faculty and trainees should be sought to understand the implications of potential understaffing on medical education; and 8) in academic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being, and patient care.

  9. Plasma fluctuations as Markovian noise.

    PubMed

    Li, B; Hazeltine, R D; Gentle, K W

    2007-12-01

    Noise theory is used to study the correlations of stationary Markovian fluctuations that are homogeneous and isotropic in space. The relaxation of the fluctuations is modeled by the diffusion equation. The spatial correlations of random fluctuations are modeled by the exponential decay. Based on these models, the temporal correlations of random fluctuations, such as the correlation function and the power spectrum, are calculated. We find that the diffusion process can give rise to the decay of the correlation function and a broad frequency spectrum of random fluctuations. We also find that the transport coefficients may be estimated by the correlation length and the correlation time. The theoretical results are compared with the observed plasma density fluctuations from the tokamak and helimak experiments.

  10. Fluctuating Thermodynamics for Biological Processes

    NASA Astrophysics Data System (ADS)

    Ham, Sihyun

    Because biomolecular processes are largely under thermodynamic control, dynamic extension of thermodynamics is necessary to uncover the mechanisms and driving factors of fluctuating processes. The fluctuating thermodynamics technology presented in this talk offers a practical means for the thermodynamic characterization of conformational dynamics in biomolecules. The use of fluctuating thermodynamics has the potential to provide a comprehensive picture of fluctuating phenomena in diverse biological processes. Through the application of fluctuating thermodynamics, we provide a thermodynamic perspective on the misfolding and aggregation of the various proteins associated with human diseases. In this talk, I will present the detailed concepts and applications of the fluctuating thermodynamics technology for elucidating biological processes. This work was supported by Samsung Science and Technology Foundation under Project Number SSTF-BA1401-13.

  11. A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections.

    PubMed

    Morrison, Aileen P; Tanasijevic, Milenko J; Torrence-Hill, Joi N; Goonan, Ellen M; Gustafson, Michael L; Melanson, Stacy E F

    2011-12-01

    The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.

  12. Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study.

    PubMed

    Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

    2017-06-01

    To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals. © Health Research and Educational Trust.

  13. Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives.

    PubMed

    Parker, Stephen; Dark, Frances; Newman, Ellie; Korman, Nicole; Meurk, Carla; Siskind, Dan; Harris, Meredith

    2016-06-02

    A novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives. The longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with

  14. 77 FR 19719 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, IBM...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ... Including Workers Whose Unemployment Insurance (UI) Wages Are Reported Through U.S. Security Fort Smith, AR... Staffing, Fort Smith, Arkansas. The workers are engaged in the production of refrigerators and trash... information shows that workers leased from Andrews International employed on-site at the Fort Smith, Arkansas...

  15. [Staffing needs of an intensive care unit in consideration of applicable hygiene guidelines--an exploratory analysis].

    PubMed

    Kochanek, M; Böll, B; Shimabukuro-Vornhagen, A; Michels, G; Barbara, W; Hansen, D; Hallek, M; Fätkenheuer, G; von Bergwelt-Baildon, M

    2015-07-01

    The patient burden in intensive care units (ICU) has continually increased worldwide over the past decades. Age, co-morbidities and an increasing complexity of conditions and treatments increase the number of patients who are either colonized or infected with antibiotic-resistant pathogens. To prevent nosocomial infections, hygiene guidelines play an important role. In this paper, we investigate the time needed for nursing of five hypothetical critically ill patients in the intensive care unit. The results show that current staffing is not sufficient under the given hygiene guidelines and that a nurse to patient ratio of one will be necessary to meet the requirements. In a national survey of university hospitals, however, we found that the current nurse to patient ratio is 1: 2.47 in German intensive care units. The apparent staffing shortage is compensated by an extraordinary personal commitment of nurses caring for patients in the ICU. © Georg Thieme Verlag KG Stuttgart · New York.

  16. 76 FR 61742 - Unimin Corporation Including On-Site Leased Workers From Staffmark and Elwood Staffing Aurora, IN...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-05

    ... Unimin Corporation. The Department has determined that these workers were sufficiently under the control... Including On-Site Leased Workers From Staffmark and Elwood Staffing Aurora, IN; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance and Alternative Trade Adjustment Assistance...

  17. Fluctuations in Cerebral Hemodynamics

    DTIC Science & Technology

    2003-12-01

    Determination of scaling properties Detrended Fluctuations Analysis (see (28) and references therein) is commonly used to determine scaling...pressure (averaged over a cardiac beat) of a healthy subject. First 1000 values of the time series are shown. (b) Detrended fluctuation analysis (DFA...1000 values of the time series are shown. (b) Detrended fluctuation analysis of the time series shown in (a). Fig . 3 Side-by-side boxplot for the

  18. Characteristics and Working Conditions of Moonlighting Teachers: Evidence from the 2011-2012 Schools and Staffing Survey

    ERIC Educational Resources Information Center

    Fitchett, Paul G.; Heafner, Tina L.; Harden, Susan B.

    2016-01-01

    Moonlighting, an employment practice where individuals work outside of their primary job, is popular within the public education sector. Using data from the National Center for Education Statistics Schools and Staffing Survey, this study examined both the characteristics and motivations of public school teachers across moonlighting categories.…

  19. Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia.

    PubMed

    Tjoa, Aaron; Kapihya, Margaret; Libetwa, Miriam; Schroder, Kate; Scott, Callie; Lee, Joanne; McCarthy, Elizabeth

    2010-06-30

    The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment. Supplemental interventions targeting

  20. Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

    PubMed Central

    2010-01-01

    Background The Ministry of Health (MOH) in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH) strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007), the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health training school enrolment

  1. 77 FR 29362 - Kohler Company, Malvern Division, Including On-Site Leased Workers From Manpower Staffing and Dow...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-17

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-81,299] Kohler Company, Malvern Division, Including On-Site Leased Workers From Manpower Staffing and Dow Cleaning Services, Malvern, AR; Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance In accordance with...

  2. Fluctuation solution theory of pure fluids

    NASA Astrophysics Data System (ADS)

    Ploetz, Elizabeth A.; Pallewela, Gayani N.; Smith, Paul E.

    2017-03-01

    Fluctuation Solution Theory (FST) provides an alternative view of fluid thermodynamics in terms of pair fluctuations in the particle number and excess energy observed for an equivalent open system. Here we extend the FST approach to provide a series of triplet and quadruplet particle and excess energy fluctuations that can also be used to help understand the behavior of fluids. The fluctuations for the gas, liquid, and supercritical regions of three fluids (H2O, CO2, and SF6) are then determined from accurate equations of state. Many of the fluctuating quantities change sign on moving from the gas to liquid phase and, therefore, we argue that the fluctuations can be used to characterize gas and liquid behavior. Further analysis provides an approach to isolate contributions to the excess energy fluctuations arising from just the intermolecular interactions and also indicates that the triplet and quadruplet particle fluctuations are related to the pair particle fluctuations by a simple power law for large regions of the phase diagram away from the critical point.

  3. 77 FR 42497 - Information Collection(s) Being Submitted for Review and Approval to the Office of Management and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-19

    ... officer (a post staffed 24 hours a day) in the FCC's Communications and Crisis Management Center in... Approval to the Office of Management and Budget (OMB) AGENCY: Federal Communications Commission. ACTION... comments to Nicholas A. Fraser, Office of Management and Budget (OMB), via fax at 202-395-5167 or via...

  4. The relation between skin friction fluctuations and turbulent fluctuating velocities in turbulent boundary layers

    NASA Astrophysics Data System (ADS)

    Diaz Daniel, Carlos; Laizet, Sylvain; Vassilicos, John Christos

    2015-11-01

    The Townsend-Perry hypothesis of wall-attached eddies relates the friction velocity uτ at the wall to velocity fluctuations at a position y from the wall, resulting in a wavenumber range where the streamwise fluctuating velocity spectrum scales as E (k) ~k-1 and the corresponding structure function scales as uτ2 in the corresponding length-scale range. However, this model does not take in account the fluctuations of the skin friction velocity, which are in fact strongly intermittent. A DNS of zero-pressure gradient turbulent boundary layer suggests a 10 to 15 degree angle from the lag of the peak in the cross-correlations between the fluctuations of the shear stress and streamwise fluctuating velocities at different heights in the boundary layer. Using this result, it is possible to refine the definition of the attached eddy range of scales, and our DNS suggests that, in this range, the second order structure function depends on filtered skin friction fluctuations in a way which is about the same at different distances from the wall and different local Reynolds numbers.

  5. The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes--A cross-sectional study.

    PubMed

    Zúñiga, Franziska; Ausserhofer, Dietmar; Hamers, Jan P H; Engberg, Sandra; Simon, Michael; Schwendimann, René

    2015-09-01

    Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). Nursing homes from all three language regions of Switzerland. A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically

  6. Inside the Pre-K Classroom: A Study of Staffing and Stability in State-Funded Prekindergarten Programs.

    ERIC Educational Resources Information Center

    Bellm, Dan; Burton, Alice; Whitebook, Marcy; Broatch, Linda; Young, Marci P.

    In response to increasing concerns about preparing young children to succeed in the primary grades, many states have increased their investment in prekindergarten programs over the past decade. Noting that increased demand for prekindergarten education coincides with a staffing shortage in the early care and education, this study documented the…

  7. Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues.

    PubMed

    Pandit, Jaideep J; Dexter, Franklin

    2009-06-01

    At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously. We used Monte-Carlo simulation using normal and Weibull distributions to estimate the times to complete lists of cases scheduled into such 8 h sessions. For each combination of mean and standard deviation, inefficiencies of use of OR time were determined for 10 h versus 8 h of staffing. When the mean actual hours of OR time used averages < or = 8 h 25 min, 8 h of staffing has higher OR efficiency than 10 h for all combinations of standard deviation and relative cost of over-run to under-run. When mean > or = 8 h 50 min, 10 h staffing has higher OR efficiency. For 8 h 25 min < mean < 8 h 50 min, the economic break-even point depends on conditions. For example, break-even is: (a) 8 h 27 min for Weibull, standard deviation of 60 min and relative cost of over-run to under-run of 2.0 versus (b) 8 h 48 min for normal, standard deviation of 0 min and relative cost ratio of 1.50. Although the simplest decision rule would be to staff for 8 h if the mean workload is < or = 8 h 40 min and to staff for 10 h otherwise, performance was poor. For example, for the Weibull distribution with mean 8 h 40 min, standard deviation 60 min, and relative cost ratio of 2.00, the inefficiency of use of OR time would be 34% larger if staffing were planned for 8 h instead of 10 h. For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages < or = 8 h 25 min, plan 8 h staffing. If average > or = 8 h 50 min, plan 10 h staffing

  8. The effects of climatic fluctuations and extreme events on running water ecosystems

    PubMed Central

    Woodward, Guy; Bonada, Núria; Brown, Lee E.; Death, Russell G.; Durance, Isabelle; Gray, Clare; Hladyz, Sally; Ledger, Mark E.; Milner, Alexander M.; Ormerod, Steve J.; Thompson, Ross M.

    2016-01-01

    Most research on the effects of environmental change in freshwaters has focused on incremental changes in average conditions, rather than fluctuations or extreme events such as heatwaves, cold snaps, droughts, floods or wildfires, which may have even more profound consequences. Such events are commonly predicted to increase in frequency, intensity and duration with global climate change, with many systems being exposed to conditions with no recent historical precedent. We propose a mechanistic framework for predicting potential impacts of environmental fluctuations on running-water ecosystems by scaling up effects of fluctuations from individuals to entire ecosystems. This framework requires integration of four key components: effects of the environment on individual metabolism, metabolic and biomechanical constraints on fluctuating species interactions, assembly dynamics of local food webs, and mapping the dynamics of the meta-community onto ecosystem function. We illustrate the framework by developing a mathematical model of environmental fluctuations on dynamically assembling food webs. We highlight (currently limited) empirical evidence for emerging insights and theoretical predictions. For example, widely supported predictions about the effects of environmental fluctuations are: high vulnerability of species with high per capita metabolic demands such as large-bodied ones at the top of food webs; simplification of food web network structure and impaired energetic transfer efficiency; and reduced resilience and top-down relative to bottom-up regulation of food web and ecosystem processes. We conclude by identifying key questions and challenges that need to be addressed to develop more accurate and predictive bio-assessments of the effects of fluctuations, and implications of fluctuations for management practices in an increasingly uncertain world. PMID:27114576

  9. Simulation modeling for the health care manager.

    PubMed

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  10. Fluctuating Selection in the Moran

    PubMed Central

    Dean, Antony M.; Lehman, Clarence; Yi, Xiao

    2017-01-01

    Contrary to classical population genetics theory, experiments demonstrate that fluctuating selection can protect a haploid polymorphism in the absence of frequency dependent effects on fitness. Using forward simulations with the Moran model, we confirm our analytical results showing that a fluctuating selection regime, with a mean selection coefficient of zero, promotes polymorphism. We find that increases in heterozygosity over neutral expectations are especially pronounced when fluctuations are rapid, mutation is weak, the population size is large, and the variance in selection is big. Lowering the frequency of fluctuations makes selection more directional, and so heterozygosity declines. We also show that fluctuating selection raises dn/ds ratios for polymorphism, not only by sweeping selected alleles into the population, but also by purging the neutral variants of selected alleles as they undergo repeated bottlenecks. Our analysis shows that randomly fluctuating selection increases the rate of evolution by increasing the probability of fixation. The impact is especially noticeable when the selection is strong and mutation is weak. Simulations show the increase in the rate of evolution declines as the rate of new mutations entering the population increases, an effect attributable to clonal interference. Intriguingly, fluctuating selection increases the dn/ds ratios for divergence more than for polymorphism, a pattern commonly seen in comparative genomics. Our model, which extends the classical neutral model of molecular evolution by incorporating random fluctuations in selection, accommodates a wide variety of observations, both neutral and selected, with economy. PMID:28108586

  11. Organizational Futures: Staffing Research Libraries in the 1990s. Minutes of the [Semiannual] Meeting of the Association of Research Libraries (105th, Washington, D.C., October 24-25, 1984).

    ERIC Educational Resources Information Center

    Association of Research Libraries, Washington, DC.

    Program presentations on issues related to staffing considerations in research libraries and business meeting minutes are combined in this report from the Association of Research Libraries (ARL). Under the program title, "Organizational Futures: Staffing Research Libraries in the 1990's," a report by the Task Force on Research Library Staffing…

  12. ACCF/AHA/HFSA 2011 survey results: current staffing profile of heart failure programs, including programs that perform heart transplant and mechanical circulatory support device implantation.

    PubMed

    Jessup, Mariell; Albert, Nancy M; Lanfear, David E; Lindenfeld, JoAnn; Massie, Barry M; Walsh, Mary Norine; Zucker, Mark J

    2011-05-01

    There have been no published recommendations about staffing needs for a heart failure (HF) clinic or an office setting focused on heart transplant. The goal of this survey was to understand the current staffing environment of HF, transplant, and mechanical circulatory support device (MCSD) programs in the United States and abroad. This report identifies current staffing patterns but does not endorse a particular staffing model. An online survey, jointly sponsored by the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and the Heart Failure Society of America (HFSA), was sent to the members of all 3 organizations who had identified themselves as interested in HF, heart transplant, or both, between March 12, 2009, and May 12, 2009. The overall response rate to the 1,823 e-mail surveys was 23%. There were 257 unique practices in the United States (81% of total sites) and 58 international sites (19%); approximately 30% of centers were in a cardiovascular group practice and 30% in a medical school hospital setting. The large majority of practices delivered HF care in both an inpatient and outpatient environment, and slightly more centers were implanting MCSDs (47%) than performing cardiac transplantation (39%). Most practices (43%) were small, with <4 staff members, or small- to medium-sized (34%), with 4 to 10 staff members, with only 23% being medium (11-20 staff) or large programs (>20 staff). On average, a U.S. HF practice cared for 1,641 outpatients annually. An average HF program with transplant performed 10 transplants. Although larger programs were able to perform more transplants and see more outpatient HF visits, their clinician staffing volume tended to double for approximately every 500 to 700 additional HF visits annually. The average staffing utilization was 2.65 physician full-time equivalents (FTEs), 2.21 nonphysician practitioner (nurse practitioner or physician assistant) FTEs, and 2.61

  13. Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study

    PubMed Central

    Lukewich, Julia; Edge, Dana S.; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

    2016-01-01

    Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Methods: Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio. Results: Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively). Interpretation: The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting

  14. Female and Male Enrollment and Staffing in Secondary and Postsecondary Occupational Education in Nevada between 1984-1991.

    ERIC Educational Resources Information Center

    Quon, Denise K.; And Others

    A study examined occupational education student enrollments and instructional staffing at the secondary and postsecondary levels in Nevada from 1984 to 1991. It focused on gender compositions within general occupational education areas and specifically concentrated on changes over the period for the traditionally underrepresented gender within…

  15. Managers' use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact.

    PubMed

    Burton, Christopher; Rycroft-Malone, Jo; Williams, Lynne; Davies, Siân; McBride, Anne; Hall, Beth; Rowlands, Anne-M; Jones, Adrian

    2016-08-26

    Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and 'local knowledge' is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers' use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances? To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice. Ethical approval has been gained from the study's institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an explanatory programme theory of the implementation and impact of

  16. Constrained? An Analysis of U.S. Academic Library Shifts in Spending, Staffing, and Utilization, 1998-2008

    ERIC Educational Resources Information Center

    Regazzi, John J.

    2012-01-01

    The study provides an analysis of U.S. academic library spending, staffing and utilization trends from data collected during the period between 1998 and 2008. Data used in this study are part of the NCES biennial survey of approximately 3,700 degree-granting postsecondary institutions. Confirming previous studies, there has been an order of…

  17. Fluctuating Selection in the Moran.

    PubMed

    Dean, Antony M; Lehman, Clarence; Yi, Xiao

    2017-03-01

    Contrary to classical population genetics theory, experiments demonstrate that fluctuating selection can protect a haploid polymorphism in the absence of frequency dependent effects on fitness. Using forward simulations with the Moran model, we confirm our analytical results showing that a fluctuating selection regime, with a mean selection coefficient of zero, promotes polymorphism. We find that increases in heterozygosity over neutral expectations are especially pronounced when fluctuations are rapid, mutation is weak, the population size is large, and the variance in selection is big. Lowering the frequency of fluctuations makes selection more directional, and so heterozygosity declines. We also show that fluctuating selection raises d n / d s ratios for polymorphism, not only by sweeping selected alleles into the population, but also by purging the neutral variants of selected alleles as they undergo repeated bottlenecks. Our analysis shows that randomly fluctuating selection increases the rate of evolution by increasing the probability of fixation. The impact is especially noticeable when the selection is strong and mutation is weak. Simulations show the increase in the rate of evolution declines as the rate of new mutations entering the population increases, an effect attributable to clonal interference. Intriguingly, fluctuating selection increases the d n / d s ratios for divergence more than for polymorphism, a pattern commonly seen in comparative genomics. Our model, which extends the classical neutral model of molecular evolution by incorporating random fluctuations in selection, accommodates a wide variety of observations, both neutral and selected, with economy. Copyright © 2017 by the Genetics Society of America.

  18. Hadronic Correlations and Fluctuations

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Koch, Volker

    2008-10-09

    We will provide a review of some of the physics which can be addressed by studying fluctuations and correlations in heavy ion collisions. We will discuss Lattice QCD results on fluctuations and correlations and will put them into context with observables which have been measured in heavy-ion collisions. Special attention will be given to the QCD critical point and the first order co-existence region, and we will discuss how the measurement of fluctuations and correlations can help in an experimental search for non-trivial structures in the QCD phase diagram.

  19. Inequitable Access to Gifted Education: Variance in Funding and Staffing Based on Locale and Contextual School Variables

    ERIC Educational Resources Information Center

    Kettler, Todd; Russell, Joseph; Puryear, Jeb S.

    2015-01-01

    This study examined discrepancies in educational opportunity for gifted students at the program services level. School districts in the study (N = 1,029) varied in expenditures for gifted education and the allocation of faculty for gifted education. The relationships of variables representing funding and staffing gifted education and school…

  20. 75 FR 45166 - Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-02

    ... Window Division, Including On-Site Leased Workers of Nicolet Staffing, Hawkins, WI; Notice of Negative... imports of wood- and aluminum- clad windows and patio doors did not contribute to worker group separations... of wood- and aluminum-clad windows and patio doors during 2007, 2008, January through April 2008, and...

  1. Value-Based Emergency Management.

    PubMed

    Corrigan, Zachary; Winslow, Walter; Miramonti, Charlie; Stephens, Tim

    2016-02-01

    This article touches on the complex and decentralized network that is the US health care system and how important it is to include emergency management in this network. By aligning the overarching incentives of opposing health care organizations, emergency management can become resilient to up-and-coming changes in reimbursement, staffing, and network ownership. Coalitions must grasp the opportunity created by changes in value-based purchasing and impending Centers for Medicare and Medicaid Services emergency management rules to engage payers, physicians, and executives. Hope and faith in doing good is no longer enough for preparedness and health care coalitions; understanding how physicians are employed and health care is delivered and paid for is now necessary. Incentivizing preparedness through value-based compensation systems will become the new standard for emergency management.

  2. Fluctuating ideal-gas lattice Boltzmann method with fluctuation dissipation theorem for nonvanishing velocities.

    PubMed

    Kaehler, G; Wagner, A J

    2013-06-01

    Current implementations of fluctuating ideal-gas descriptions with the lattice Boltzmann methods are based on a fluctuation dissipation theorem, which, while greatly simplifying the implementation, strictly holds only for zero mean velocity and small fluctuations. We show how to derive the fluctuation dissipation theorem for all k, which was done only for k=0 in previous derivations. The consistent derivation requires, in principle, locally velocity-dependent multirelaxation time transforms. Such an implementation is computationally prohibitively expensive but, with a small computational trick, it is feasible to reproduce the correct FDT without overhead in computation time. It is then shown that the previous standard implementations perform poorly for non vanishing mean velocity as indicated by violations of Galilean invariance of measured structure factors. Results obtained with the method introduced here show a significant reduction of the Galilean invariance violations.

  3. Review of Related Literature and Research: History of Merit Pay, Differentiated Staffing, and Incentive Pay Programs.

    ERIC Educational Resources Information Center

    Guernsey, Marsha A.

    This paper reviews selected literature pertaining to merit pay, differentiated staffing, and incentive pay programs. The first section reviews the history of these alternatives to the single salary schedule, beginning with an account of two experimental merit pay plans in the early 20th century. During the 1920s, merit pay plans gave way to the…

  4. Career and Technical Education Teachers and Schools: Results from the 2011-12 Schools and Staffing Survey

    ERIC Educational Resources Information Center

    Hensley, Elizabeth; Ottem, Randolph; Levesque, Karen

    2017-01-01

    This report uses data drawn from the 2011-12 Schools and Staffing Survey (SASS:12), administered by the National Center for Education Statistics (NCES) in the U.S. Department of Education, to present an in-depth look at the career and technical education (CTE) teaching profession today. The purpose of this report is to provide policymakers and…

  5. Fully Quantum Fluctuation Theorems

    NASA Astrophysics Data System (ADS)

    Åberg, Johan

    2018-02-01

    Systems that are driven out of thermal equilibrium typically dissipate random quantities of energy on microscopic scales. Crooks fluctuation theorem relates the distribution of these random work costs to the corresponding distribution for the reverse process. By an analysis that explicitly incorporates the energy reservoir that donates the energy and the control system that implements the dynamic, we obtain a quantum generalization of Crooks theorem that not only includes the energy changes in the reservoir but also the full description of its evolution, including coherences. Moreover, this approach opens up the possibility for generalizations of the concept of fluctuation relations. Here, we introduce "conditional" fluctuation relations that are applicable to nonequilibrium systems, as well as approximate fluctuation relations that allow for the analysis of autonomous evolution generated by global time-independent Hamiltonians. We furthermore extend these notions to Markovian master equations, implicitly modeling the influence of the heat bath.

  6. Can mercury in fish be reduced by water level management? Evaluating the effects of water level fluctuation on mercury accumulation in yellow perch (Perca flavescens)

    USGS Publications Warehouse

    Larson, James H.; Maki, Ryan P.; Knights, Brent C.; Gray, Brian R.

    2014-01-01

    Mercury (Hg) contamination of fisheries is a major concern for resource managers of many temperate lakes. Anthropogenic Hg contamination is largely derived from atmospheric deposition within a lake’s watershed, but its incorporation into the food web is facilitated by bacterial activity in sediments. Temporal variation in Hg content of fish (young-of-year yellow perch) in the regulated lakes of the Rainy–Namakan complex (on the border of the United States and Canada) has been linked to water level (WL) fluctuations, presumably through variation in sediment inundation. As a result, Hg contamination of fish has been linked to international regulations of WL fluctuation. Here we assess the relationship between WL fluctuations and fish Hg content using a 10-year dataset covering six lakes. Within-year WL rise did not appear in strongly supported models of fish Hg, but year-to-year variation in maximum water levels (∆maxWL) was positively associated with fish Hg content. This WL effect varied in magnitude among lakes: In Crane Lake, a 1 m increase in ∆maxWL from the previous year was associated with a 108 ng increase in fish Hg content (per gram wet weight), while the same WL change in Kabetogama was associated with only a 5 ng increase in fish Hg content. In half the lakes sampled here, effect sizes could not be distinguished from zero. Given the persistent and wide-ranging extent of Hg contamination and the large number of regulated waterways, future research is needed to identify the conditions in which WL fluctuations influence fish Hg content.

  7. Managing Technology Resourcefully: Part II--Working with Your District's Technology

    ERIC Educational Resources Information Center

    Weeks, Richard

    2009-01-01

    A large school district may have a technology department staffed by a chief technology officer who supervises two or more directors of operations, project managers, and technicians. On the other hand, a small district may employ an information technologist who works with technicians, consultants, volunteers with a knack for technology, and…

  8. Managing Smallness: Promising Fiscal Practices for Rural School District Administrators.

    ERIC Educational Resources Information Center

    Freitas, Deborah Inman

    Based on a mail survey of over 100 rural school administrators in 34 states, this handbook outlines common problems and successful strategies in the financial management of rural, small school districts. Major problems are related to revenue and cash flow, increasing expenditures, providing quality education programs, and staffing to handle the…

  9. Economic Incentives as a Strategy for Responding to Teacher Staffing Problems: A Typology of Policies and Practices

    ERIC Educational Resources Information Center

    Kolbe, Tammy; Strunk, Katharine O.

    2012-01-01

    Background: Many district and school leaders experience difficulties staffing their classrooms with qualified teachers. Economic incentives may motivate teachers to enter and remain in the workforce and entice teachers to work in less desirable districts and schools. However, very little is known about incentives in use, how they are used to…

  10. Principals' Time, Tasks, and Professional Development: An Analysis of Schools and Staffing Survey Data. REL 2017-201

    ERIC Educational Resources Information Center

    Lavigne, Heather J.; Shakman, Karen; Zweig, Jacqueline; Greller, Sara L.

    2016-01-01

    This study describes how principals reported spending their time and what professional development they reported participating in, based on data collected through the Schools and Staffing Survey by the National Center for Education Statistics during the 2011/12 school year. The study analyzes schools by grade level, poverty level, and within…

  11. Instructional Investment or Administrative Bloat: The Effects of Charter System Conversion on Resource Allocations and Staffing Patterns

    ERIC Educational Resources Information Center

    Kramer, Dennis A., II; Lane, Megan; Tanner, Melvin

    2017-01-01

    Despite the growing call for local autonomy and flexibility, few scholars have examined the role of school district-level flexibility on resource allocation and staffing patterns. Leveraging the charter system law within the State of Georgia, we utilize a generalized difference-in-differences approach to estimate the impact of flexibility of…

  12. United States Catholic Elementary and Secondary Schools 1993-1994. Annual Statistical Report on Schools, Enrollment and Staffing.

    ERIC Educational Resources Information Center

    Brigham, Frederick H., Jr.

    Since 1969-70, the National Catholic Educational Association has published a statistical report on Catholic elementary and secondary schools in the United States. This year's report contains the core school enrollment and staffing data from the Association's database and includes data on Chapter 1 services, extended care programs, school boards of…

  13. Schools and Staffing Survey (SASS). Papers Presented at Meetings of the American Statistical Association. Working Paper Series.

    ERIC Educational Resources Information Center

    National Center for Education Statistics (ED), Washington, DC.

    The Schools and Staffing Survey (SASS) is an integrated system of surveys of public and private schools, school districts, school administrators, and teachers conducted by the National Center for Education Statistics (NCES). This collection contains papers related to the SASS presented at meetings of the American Statistical Association in August…

  14. Theory of slightly fluctuating ratchets

    NASA Astrophysics Data System (ADS)

    Rozenbaum, V. M.; Shapochkina, I. V.; Lin, S. H.; Trakhtenberg, L. I.

    2017-04-01

    We consider a Brownian particle moving in a slightly fluctuating potential. Using the perturbation theory on small potential fluctuations, we derive a general analytical expression for the average particle velocity valid for both flashing and rocking ratchets with arbitrary, stochastic or deterministic, time dependence of potential energy fluctuations. The result is determined by the Green's function for diffusion in the time-independent part of the potential and by the features of correlations in the fluctuating part of the potential. The generality of the result allows describing complex ratchet systems with competing characteristic times; these systems are exemplified by the model of a Brownian photomotor with relaxation processes of finite duration.

  15. 77 FR 63873 - Johnson Controls, Inc. Including On-Site Leased Workers of Valley Staffing and AZ Quality Hudson...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-17

    ... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson..., Wisconsin location of Johnson Controls, Inc. The Department has determined that these workers were sufficiently under the control of the subject firm to be considered leased workers. Based on these findings...

  16. 78 FR 15048 - SGL Carbon, LLC Including Leased On-Site Worker of Reflex Staffing Services and Manpower, St...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-08

    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,113] SGL Carbon, LLC Including Leased On-Site Worker of Reflex Staffing Services and Manpower, St. Marys, Pennsylvania; Notice of... of graphite parts. The initial investigation resulted in a negative determination based on the...

  17. Proven Techniques: The Use and Impact of Major Management Concepts in Community Colleges.

    ERIC Educational Resources Information Center

    Deegan, William L.

    1992-01-01

    Describes a survey of community college presidents' use of and perception of the effectiveness of major management concepts related to planning, organization, budgeting/finance, staffing, and evaluation. Also summarizes presidents' perceptions of the problems facing them and their perspectives on the future. (DMM)

  18. Standards in Action. Using National Standards for Human Resource Management and Development in Further Education. 1. Laying the Foundations.

    ERIC Educational Resources Information Center

    Further Education Unit, London (England).

    This booklet is designed to assist British further education college managers responsible for quality assurance, human resources management (HRM), human resources development (HRD), corporate development, strategic planning, staffing/personnel, and curriculum in using national standards for HRM and HRD in further education. A synopsis, users'…

  19. Differential interferometry for measurement of density fluctuations and fluctuation-induced transport (invited)

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Lin, L.; Ding, W. X.; Brower, D. L.

    2010-10-15

    Differential interferometry employs two parallel laser beams with a small spatial offset (less than beam width) and frequency difference (1-2 MHz) using common optics and a single mixer for a heterodyne detection. The differential approach allows measurement of the electron density gradient, its fluctuations, as well as the equilibrium density distribution. This novel interferometry technique is immune to fringe skip errors and is particularly useful in harsh plasma environments. Accurate calibration of the beam spatial offset, accomplished by use of a rotating dielectric wedge, is required to enable broad application of this approach. Differential interferometry has been successfully used onmore » the Madison Symmetric Torus reversed-field pinch plasma to directly measure fluctuation-induced transport along with equilibrium density profile evolution during pellet injection. In addition, by combining differential and conventional interferometry, both linear and nonlinear terms of the electron density fluctuation energy equation can be determined, thereby allowing quantitative investigation of the origin of the density fluctuations. The concept, calibration, and application of differential interferometry are presented.« less

  20. The Spectrum of Wind Power Fluctuations

    NASA Astrophysics Data System (ADS)

    Bandi, Mahesh

    2016-11-01

    Wind is a variable energy source whose fluctuations threaten electrical grid stability and complicate dynamical load balancing. The power generated by a wind turbine fluctuates due to the variable wind speed that blows past the turbine. Indeed, the spectrum of wind power fluctuations is widely believed to reflect the Kolmogorov spectrum; both vary with frequency f as f - 5 / 3. This variability decreases when aggregate power fluctuations from geographically distributed wind farms are averaged at the grid via a mechanism known as geographic smoothing. Neither the f - 5 / 3 wind power fluctuation spectrum nor the mechanism of geographic smoothing are understood. In this work, we explain the wind power fluctuation spectrum from the turbine through grid scales. The f - 5 / 3 wind power fluctuation spectrum results from the largest length scales of atmospheric turbulence of order 200 km influencing the small scales where individual turbines operate. This long-range influence spatially couples geographically distributed wind farms and synchronizes farm outputs over a range of frequencies and decreases with increasing inter-farm distance. Consequently, aggregate grid-scale power fluctuations remain correlated, and are smoothed until they reach a limiting f - 7 / 3 spectrum. This work was funded by the Collective Interactions Unit, OIST Graduate University, Japan.