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.

Operational evaluation of high-throughput community-based mass prophylaxis using Just-in-time training.

PubMed

Spitzer, James D; Hupert, Nathaniel; Duckart, Jonathan; Xiong, Wei

2007-01-01

Community-based mass prophylaxis is a core public health operational competency, but staffing needs may overwhelm the local trained health workforce. Just-in-time (JIT) training of emergency staff and computer modeling of workforce requirements represent two complementary approaches to address this logistical problem. Multnomah County, Oregon, conducted a high-throughput point of dispensing (POD) exercise to test JIT training and computer modeling to validate POD staffing estimates. The POD had 84% non-health-care worker staff and processed 500 patients per hour. Post-exercise modeling replicated observed staff utilization levels and queue formation, including development and amelioration of a large medical evaluation queue caused by lengthy processing times and understaffing in the first half-hour of the exercise. The exercise confirmed the feasibility of using JIT training for high-throughput antibiotic dispensing clinics staffed largely by nonmedical professionals. Patient processing times varied over the course of the exercise, with important implications for both staff reallocation and future POD modeling efforts. Overall underutilization of staff revealed the opportunity for greater efficiencies and even higher future throughputs.

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

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…

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.

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

DoD Biometrics Collaboration Forum 25-27 Jan 2011. Event Report

DTIC Science & Technology

2011-03-01

GS-15 Level Staffing Marine Corps Action Tracking System ( MCATS ) Entered Staffing 21 December 2010 HQ USMC Receiving Staff Comments GO...SES Level Staffing MCATS TBD HQ USMC Assistant Commandant of the TBD HQ USMC 2011 DoD Biometrics Collaboration Forum Event Report 13...O-6/GS-15 Staffing MCATS Late March 2011 HQ USMC GO/SES Staffing MCATS Early April 2011 HQ USMC ACMC Signature TBD HQ USMC USMC

Improving patient safety by optimizing the use of nursing human resources.

PubMed

Rochefort, Christian M; Buckeridge, David L; Abrahamowicz, Michal

2015-06-14

Recent ecological studies have suggested that inadequate nurse staffing may contribute to the incidence of adverse events in acute care hospitals. However, longitudinal studies are needed to further examine these associations and to identify the staffing patterns that are of greatest risk. The aims of this study are to determine if (a) nurse staffing levels are associated with an increased risk of adverse events, (b) the risk of adverse events in relationship to nurse staffing levels is modified by the complexity of patient requirements, and (c) optimal nurse staffing levels can be established. A dynamic cohort of all adult medical, surgical, and intensive care unit patients admitted between 2010 and 2015 to a Canadian academic health center will be followed during the inpatient and 7-day post-discharge period to assess the occurrence and frequency of adverse events in relationship to antecedent nurse staffing levels. Four potentially preventable adverse events will be measured: (a) hospital-acquired pneumonia, (b) ventilator-associated pneumonia, (c) venous thromboembolism, and (d) in-hospital fall. These events were selected for their high incidence, morbidity and mortality rates, and because they are hypothesized to be related to nurse staffing levels. Adverse events will be ascertained from electronic health record data using validated automated detection algorithms. Patient exposure to nurse staffing will be measured on every shift of the hospitalization using electronic payroll records. To examine the association between nurse staffing levels and the risk of adverse events, four Cox proportional hazards regression models will be used (one for each adverse event), while adjusting for patient characteristics and risk factors of adverse event occurrence. To determine if the association between nurse staffing levels and the occurrence of adverse events is modified by the complexity of patient requirements, interaction terms will be included in the regression models, and their significance assessed. To assess for the presence of optimal nurse staffing levels, flexible nonlinear spline functions will be fitted. This study will likely generate evidence-based information that will assist managers in making the most effective use of scarce nursing resources and in identifying staffing patterns that minimize the risk of adverse events.

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

Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload 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.

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

PubMed

Coleman, Bernice; Blumenthal, Nancy; Currey, Judy; Dobbels, Fabienne; Velleca, Angela; Grady, Kathleen L; Kugler, Christiane; Murks, Catherine; Ohler, Linda; Sumbi, Christine; Luu, Minh; Dark, John; Kobashigawa, Jon; White-Williams, Connie

2015-02-01

The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing. A consensus conference with workgroup sessions, consisting of 77 nurse participants with clinical experience in cardiothoracic transplantation, was arranged. This was followed by subsequent discussion with the ISHLT Nursing, Health Science and Allied Health Council. Evidence and expert opinions regarding key issues were reviewed. A modified nominal group technique was used to reach consensus. Consensus reached included: (1) a minimum of 2 years nursing experience is required for transplant coordinators, nurse managers or advanced practice nurses; (2) a baccalaureate in nursing is the minimum education level required for a transplant coordinator; (3) transplant coordinator-specific certification is recommended; (4) nurse practitioners, clinical nurse specialists and nurse managers should hold at least a master's degree; and (5) strategies to retain transplant nurses include engaging donor call teams, mentoring programs, having flexible hours and offering career advancement support. Future research should focus on the relationships between staffing levels, nurse education and patient outcomes. Delineation of roles and guidelines for education, certification, licensure and staffing levels of transplant nurses are needed to support all nurses working at the fullest extent of their education and licensure. This consensus document provides such recommendations and draws attention to areas for future research. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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.

[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.

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.

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.

Education and Training--Research and Development: Report of Futuring Group 1

Treesearch

1987-01-01

Public agencies involved in natural resource management and fire protection will face many challenges over the next few decades, including decreasing real budgets, lower staffing levels, increasing responsibilities, expanding technologies and a more sophisticated and demanding public. In addressing these challenges, resource managers must be prepared to enter a new...

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 hospital mortality which gives the study additional credibility. This study supports claims that the availability of medical and nursing staff is associated with the survival of critically ill patients and suggests that future studies should focus on the resources of the health care team. The results emphasise the urgent need for a prospective study of staffing levels and the organisation of care in ICUs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

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.

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.

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. The grid is easily adaptable when changes to the clinical environment change, such as an increase in IMRT or IGRT applications.

Nursing Services Delivery Theory: an open system approach.

PubMed

Meyer, Raquel M; O'Brien-Pallas, Linda L

2010-12-01

This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a 'black box' that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. A search of CINAHL and Business Source Premier for the years 1980-2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. THE Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. © 2010 Blackwell Publishing Ltd.

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.

Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards-a cross sectional time series poisson regression study.

PubMed

Bowers, Len; Crowder, Martin

2012-01-01

The link between positive outcomes and qualified nurse staffing levels is well established for general hospitals. Evidence on staffing levels and outcomes for mental health nursing is more sparse, contradictory and complicated by the day to day allocation of staff resources to wards with more seriously ill patients. To assess whether rises in staffing numbers precede or follow levels of adverse incidents on the wards of psychiatric hospitals. Time series analysis of the relationship between shift to shift changes over a six month period in total conflict incidents (aggression, self-harm, absconding, drug/alcohol use, medication refusal), total containment incidents (pro re nata medication, special observation, manual restraint, show of force, time out, seclusion, coerced intramuscular medication) and nurse staffing levels. 32 acute psychiatric wards in England. At the end of every shift, nurses on the participating wards completed a checklist reporting the numbers of conflict and containment incidents, and the numbers of nursing staff on duty. Regular qualified nurse staffing levels in the preceding shifts were positively associated with raised conflict and containment levels. Conflict and containment levels in preceding shifts were not associated with nurse staffing levels. Results support the interpretation that raised qualified nurse staffing levels lead to small increases in risks of adverse incidents, whereas adverse incidents do not lead to consequent increases in staff. These results may be explicable in terms of the power held and exerted by psychiatric nurses in relation to patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

Current and Future Challenges to Resourcing U.S. Navy Public Shipyards

DTIC Science & Technology

carriers. For this reason, the public shipyards are required to maintain core capabilities that the private sector does not maintain. In addition, they are ...has been on the rise. Direct man-days of work assigned to and executed by the shipyards have increased during that time and are planned to continue to...role in future workforce management as the initiatives are broadened. Planned increases in civilian staffing levels are necessary but not sufficient to mitigate near-term execution risk at the shipyards.

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.

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…

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

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.,…

Surface Warfare Officers Initial Training For Future Success

DTIC Science & Technology

2018-03-01

updating and creating learning modules and Surface Warfare Officer School (SWOS) staffing as well as weaknesses in the methodologies used for...and Surface Warfare Officer School (SWOS) staffing as well as weaknesses in the methodologies used for training. We conclude that the Basic Division... METHODOLOGY ....................................................................................9 1. Staff Interviews

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.

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

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.

Optimizing the patient transport function at Mayo Clinic.

PubMed

Kuchera, Dustin; Rohleder, Thomas R

2011-01-01

In this article, we report on the implementation of a computerized scheduling tool to optimize staffing for patient transport at the Mayo Clinic. The tool was developed and implemented in Microsoft Excel and Visual Basic for Applications and includes an easy-to-use interface. The tool allows transport management to consider the trade-offs between patient waiting time and staffing levels. While improved staffing efficiency was a desire of the project, it was important that patient service quality was also maintained. The results show that staffing could be reduced while maintaining historical patient service levels.

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…

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.

Strategic foresight, leadership, and the future of rural healthcare staffing in the United States.

PubMed

Reimers-Hild, Connie

2018-05-01

This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends-exponential advances in science and technology and the continued evolution of the decentralized global marketplace-will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities.

Strategic foresight, leadership, and the future of rural healthcare staffing in the United States

PubMed Central

Reimers-Hild, Connie

2018-01-01

ABSTRACT This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends—exponential advances in science and technology and the continued evolution of the decentralized global marketplace—will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities. PMID:29642092

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.

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

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 experience surveys. Organisational factors contribute significantly to observed variation in the quality of care in English general practices. Levels of nurse staffing have an independent association with quality but also interact with organisational factors. The observed relationships are not necessarily causal but a causal relationship is plausible. The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated. Copyright © 2011. Published by Elsevier Ltd.

Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature.

PubMed

Stalpers, Dewi; de Brouwer, Brigitte J M; Kaljouw, Marian J; Schuurmans, Marieke J

2015-04-01

To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. Included were quantitative studies published from 2004 to 2012 that examined associations between work environment and the following patient outcomes: delirium, malnutrition, pain, patient falls and pressure ulcers. The Dutch version of Cochrane's critical appraisal instrument was used to assess the methodological quality of the included studies. Of the initial 1120 studies, 29 were included in the review. Nurse staffing was inversely related to patient falls; more favorable staffing hours were associated with fewer fall incidents. Mixed results were shown for nurse staffing in relation to pressure ulcers. Characteristics of work environment other than nurse staffing that showed significant effects were: (i) collaborative relationships; positively perceived communication between nurses and physicians was associated with fewer patient falls and lower rates of pressure ulcers, (ii) nurse education; higher levels of education were related to fewer patient falls and (iii) nursing experience; lower levels of experience were related to more patient falls and higher rates of pressure ulcers. No eligible studies were found regarding delirium and malnutrition, and only one study found that favorable staffing was related to better pain management. Our findings show that there is evidence on associations between work environment and nurse-sensitive patient outcomes. However, the results are equivocal and studies often do not provide clear conclusions. A quantitative meta-analysis was not feasible due to methodological issues in the primary studies (for example, poorly described samples). The diversity in outcome measures and the majority of cross-sectional designs make quantitative analysis even more difficult. In the future, well-described research designs of a longitudinal character will be needed in this field of work environment and nursing quality. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

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.

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.

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 administrative measures, as it reflects relevant aspects of staffing and involves an implicit adjustment for patient acuity. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

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…

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. Furthermore, improvement did not come at the cost of a reduced skill mix, as was feared. Alternative and more targeted designs, however, might yield further improvement for safety-net hospitals and reduce potential disparities in the staffing and skill mix of safety-net and non-safety-net hospitals. PMID:22428696

[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.

Nursing Services Delivery Theory: an open system approach

PubMed Central

Meyer, Raquel M; O’Brien-Pallas, Linda L

2010-01-01

meyer r.m. & o’brien-pallas l.l. (2010)Nursing services delivery theory: an open system approach. Journal of Advanced Nursing66(12), 2828–2838. Aim This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. Background The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a ‘black box’ that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. Data sources A search of CINAHL and Business Source Premier for the years 1980–2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. Discussion The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. Implications for nursing The Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. Conclusion The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. PMID:20831573

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.

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.

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.

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...

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...

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...

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...

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.

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.

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.

The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

PubMed Central

Boone, M. Dustin; Massa, Jennifer; Mueller, Ariel; Jinadasa, Sayuri P; Lee, Joon; Kothari, Rishi; Scott, Daniel J.; Callahan, Julie; Celi, Leo Anthony; Hacker, Michele R.

2016-01-01

Purpose Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing. Methods Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episode(s) were categorized according to the staffing level, defined as high during weekday daytime (7am–7pm) and low during weekends or nighttime (7pm–7am). Results Patients with a hypotensive event on a weekend were less likely to be treated compared to those that occurred during the weekday daytime (p=0.02). No association between weekday daytime versus weekday nighttime staffing levels and treatment of hypotension was found (RR 1.02; 95% CI 0.98–1.07). Conclusion Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels. PMID:26975737

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 stay of patients. © 2017 Sigma Theta Tau International.

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 ...

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%.

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.

Resource Allocation and Resident Outcomes In Nursing Homes: Comparisons between the Best and Worst1

PubMed Central

Anderson, Ruth A.; Hsieh, Pi-Ching; Su, Hui-Fang

2005-01-01

The purpose of this study was to identify patterns of resource allocation that related to resident outcomes in nursing homes. Data on structure, staffing levels, salaries, cost, casemix, and resident outcomes were obtained from state-level, administrative databases on 494 nursing homes. We identified two sets of comparison groups and showed that the group of homes with the greatest percentage of improvement in resident outcomes had higher levels of RN staffing and higher costs. However, comparison groups based on best/worst average outcomes did not differ in resource allocation patterns. Additional analysis demonstrated that when controlling for RN staffing, resident outcomes in high and low cost homes did not differ. The results suggest that, although RN staffing is more expensive, it is key to improving resident outcomes. PMID:9679807

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…

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…

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.

Nursing operations automation and health care technology innovations: 2025 and beyond.

PubMed

Suby, ChrysMarie

2013-01-01

This article reviews why nursing operations automation is important, reviews the impact of computer technology on nursing from a historical perspective, and considers the future of nursing operations automation and health care technology innovations in 2025 and beyond. The increasing automation in health care organizations will benefit patient care, staffing and scheduling systems and central staffing offices, census control, and measurement of patient acuity.

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.

Assessment of pharmacy manpower and services in West Virginia.

PubMed

Robinson, Evan T; Bowyer, David

2006-09-01

The shortage of pharmacists across the nation has been much publicized and has been identified as one of the reasons for new schools of pharmacy to open or for existing colleges and schools of pharmacy to increase their class sizes. This article represents the assessment of a new school of pharmacy's evaluation of staffing and practice in its geographic area. This survey represents the first data point within the School of Pharmacy assessment plan and will be repeated at several intervals after the program opens to longitudinally evaluate its impact on pharmacy staffing and services within West Virginia. Using a modified Dillman survey methodology a random sample of 548 pharmacists in West Virginia, approximately one-third the active roster, were surveyed regarding staffing and services in West Virginia. A response rate of 32.78% was achieved and findings indicated that there is a staffing shortage of pharmacists within West Virginia, that staffing impacts the services pharmacists provide, and that more pharmacists would be willing to offer disease management services if staffing levels were at appropriate levels. A shortage of pharmacists does exist in West Virginia and it has implications on patient care. Longitudinal evaluation of the impact of a new pharmacy program will be conducted and the staffing and services within West Virginia should be continued to be studied.

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.

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.

Hours per Patient Day: Not the Problem, Nor the Solution.

PubMed

Kirby, Karen K

2015-01-01

Hours per patient day (HPPD) is a metric that is easy to use in determining budgeted FTE and in comparing staffing across organizations. There are many considerations in determining the appropriate HPPD. The combination of automated patient acuity, staffing, and human resource systems provide a wealth of information for determining the budgeted HPPD and in making defensible requests for adjustments in HPPD. No matter how much data we have about staffing levels, nurse education and skill levels, the environment of care, or patient acuity, the real key is determining the outcomes we need to compare staffing against. We must quantify the savings associated with positive outcomes and get this information in the hands of the public so they can make informed decisions.

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 reshape policy, adopt workload-based norms, review scopes of practice and target human resource investments. In the near term, the government could redistribute existing health workers to improve staffing equity in line with the WISN results. Longer term revision of staffing norms and investments to effectively reflect actual workloads and ensure provision of quality services at all levels is needed.

[Personnel requirements of medical radiation physics in radiotherapy in comparison to the current guidelines "radiation protection in medicine" : Special consideration of intensity-modulated radiation therapy].

PubMed

Leetz, H-K; Eipper, H H; Gfirtner, H; Schneider, P; Welker, K

2014-08-01

In 1994 and 1998 reports on staffing levels in medical radiation physics for radiation therapy were published by the "Deutsche Gesellschaft für Medizinische Physik" (DGMP, German Society for Medical Physics). Because of the technical and methodological progress, changes in recommended qualifications of staff and new governmental regulations, it was necessary to establish new staffing levels. The data were derived from a new survey in clinics. Some of the previously established results from the old reports were adapted to the new conditions by conversion.The staffing requirements were normalized to main components as in the earlier reports resulting in a simple method for calculation of staffing levels. The results were compared with the requirements in the "Richtlinie Strahlenschutz in der Medizin" (guidelines on radiation protection in medicine) and showed satisfactory agreement.

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.

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.

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.

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 assessment and allocation of staffing and workloads.

75 FR 24392 - Further Consolidation of CBP Drawback Centers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

.... Comment: A commenter expressed concern about the proper staffing levels at the San Francisco Drawback... workload. CBP will continually monitor drawback specialist staffing levels so that each of the CBP Drawback... solicited public input, and did not receive any comments challenging that finding. We certify, therefore...

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…

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,…

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,…

[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.

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

Civilian Personnel Administration in the Army: Deciding the Future of the Program

DTIC Science & Technology

1993-04-28

identifies four domains (1982, 50): staffing, development, appraisal, and rewards. Ulrich , Brockbank , and Yeung (1989, 314) suggest six: staffing, development...1989, 112-114; Ulrich 1987, 169- 171; Meshoulam and Baird 1987, 485; Coates 1987, 221-228). This turbulent environment, both internal and external to...this environment is for a business to recognize the value of and leverage the capabilities of its human resources ( Ulrich 1987, 171-173; Wilhelm 1990

The Effect of Personnel Stability on Marine Corps Readiness: Are Infantry Battalions Ready to Respond to Future Conflicts?

DTIC Science & Technology

2015-12-01

of staffing and support for this vital function within the command. Similar to professional sports , this research believes adding support for...DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) The “next man up” slogan may be acceptable for competitive sports , but it seems more...This research questions whether the Marine Corps’ manning and staffing policies are adequately setting the conditions for infantry battalions to achieve

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.

School Librarian Staffing Levels and Student Achievement as Represented in 2006-2009 Kansas Annual Yearly Progress Data

ERIC Educational Resources Information Center

Dow, Mirah J.; McMahon-Lakin, Jacqueline

2012-01-01

To address the presence or absence of school librarians in Kansas public schools, a study using analysis of covariance (ANCOVA) was designed to investigate staffing levels for library media specialists (LMSs), the label used for school librarians in licensed-personnel data in Kansas, and student achievement at the school level. Five subject areas…

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.

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, nurse researchers should be more actively engaged in the design and implementation of economic evaluation studies of the services they provide. Copyright © 2010 Elsevier Ltd. All rights reserved.

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.

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 compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads. PMID:26599959

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…

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

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.

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

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.

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 as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors. The findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis. Copyright © 2016 Elsevier Ltd. All rights reserved.

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.

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

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.

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.

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 complex. Increasing staffing levels or the ratio of registered nurses alone is not likely sufficient for increasing quality of care. PMID:22123029

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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.

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

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 and innovative thinking about nurse staffing across all health care settings, a second goal is to stimulate additional publications. This includes a goal of at least 20 articles in Nursing Economic$ on best practices in staffing and care models from across the continuum over the next 3 years.

Reducing Operating Costs by Optimizing Space in Facilities

DTIC Science & Technology

2012-03-01

Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

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…

[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.

[A proposal to improve nursing fee differentiation policy for general hospitals using profitability-analysis in the national health insurance].

PubMed

Kim, Sungjae; Kim, Jinhyun

2012-06-01

The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

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.

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.

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.

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.

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...

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...

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.

Is there an economic case for investing in nursing care – what does the literature tell us?

PubMed Central

Twigg, Diane E; Myers, Helen; Duffield, Christine; Giles, Margaret; Evans, Gemma

2015-01-01

Aim To determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients? Background Research has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions. Design A systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence. Data sources The MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits. Review methods The review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes. Results Four-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results. Conclusion This review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies. PMID:25430080

The cost of nurse-sensitive adverse events.

PubMed

Pappas, Sharon Holcombe

2008-05-01

The aim of this study was to describe the methodology for nursing leaders to determine the cost of adverse events and effective levels of nurse staffing. The growing transparency of quality and cost outcomes motivates healthcare leaders to optimize the effectiveness of nurse staffing. Most hospitals have robust cost accounting systems that provide actual patient-level direct costs. These systems allow an analysis of the cost consumed by patients during a hospital stay. By knowing the cost of complications, leaders have the ability to justify the cost of improved staffing when quality evidence shows that higher nurse staffing improves quality. An analysis was performed on financial and clinical data from hospital databases of 3,200 inpatients. The purpose was to establish a methodology to determine actual cost per case. Three diagnosis-related groups were the focus of the analysis. Five adverse events were analyzed along with the costs. A regression analysis reported that the actual direct cost of an adverse event was dollars 1,029 per case in the congestive heart failure cases and dollars 903 in the surgical cases. There was a significant increase in the cost per case in medical patients with urinary tract infection and pressure ulcers and in surgical patients with urinary tract infection and pneumonia. The odds of pneumonia occurring in surgical patients decreased with additional registered nurse hours per patient day. Hospital cost accounting systems are useful in determining the cost of adverse events and can aid in decision making about nurse staffing. Adverse events add costs to patient care and should be measured at the unit level to adjust staffing to reduce adverse events and avoid costs.

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.

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

RN jurisdiction over nursing care systems in nursing homes: application of latent class analysis

PubMed Central

Corazzini, Kirsten N.; Anderson, Ruth A.; Mueller, Christine; Thorpe, Joshua M.; McConnell, Eleanor S.

2015-01-01

Background In the context of declining registered nurse (RN) staffing levels in nursing homes, professional nursing jurisdiction over nursing care systems may erode. Objectives The purpose of this study is to develop a typology of professional nursing jurisdiction in nursing homes in relation to characteristics of RN staffing, drawing upon Abbott's (1988) tasks and jurisdictions framework. Method The study was a cross-sectional, observational study using the 2004 National Nursing Home Survey (N=1,120 nursing homes). Latent class analysis tested whether RN staffing indicators differentiated facilities in a typology of RN jurisdiction, and compared classes on key organizational environment characteristics. Multiple logistic regression analysis related the emergent classes to presence or absence of specialty care programs in 8 clinical areas. Results Three classes of capacity for jurisdiction were identified, including ‘low capacity’ (41% of homes) with low probabilities of having any indicators of RN jurisdiction, ‘mixed capacity’ (26% of homes) with moderate to high probabilities of having higher RN education and staffing levels, and ‘high capacity’ (32% of homes) with moderate to high probabilities of having almost all indicators of RN jurisdiction. ‘High capacity’ homes were more likely to have specialty care programs relative to ‘low capacity’ homes; such homes were less likely to be chain-owned, and more likely to be larger, provide higher technical levels of patient care, have unionized nursing assistants, have a lower ratio of LPNs to RNs, and a higher education level of the administrator. Discussion Findings provide preliminary support for the theoretical framework as a starting point to move beyond extensive reliance on staffing levels and mix as indicators of quality. Further, findings indicate the importance of RN specialty certification. PMID:22166907

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.

Predicting future staffing needs at teaching hospitals: use of an analytical program with multiple variables.

PubMed

Mitchell, Christine C; Ashley, Stanley W; Zinner, Michael J; Moore, Francis D

2007-04-01

To develop a model to predict future staffing for the surgery service at a teaching hospital. Tertiary hospital. A computer model with potential future variables was constructed. Some of the variables were distribution of resident staff, fellows, and physician extenders; salary/wages; work hours; educational value of rotations; work units, inpatient wards, and clinics; future volume growth; and efficiency savings. Outcomes Number of staff to be hired, staffing expense, and educational impact. On a busy general surgery service, we estimated the impact of changes in resident work hours, service growth, and workflow efficiency in the next 5 years. Projecting a reduction in resident duty hours to 60 hours per week will require the hiring of 10 physician assistants at a cost of $1 134 000, a cost that is increased by $441 000 when hiring hospitalists instead. Implementing a day of didactic and simulator time (10 hours) will further increase the costs by $568 000. A 10% improvement in the efficiency of floor care, as might be gained by advanced information technology capability or by regionalization of patients, can mitigate these expenses by as much as 21%. On the other hand, a modest annual growth of 2% will increase the costs by $715 000 to $2 417 000. To simply replace residents with alternative providers requires large amounts of human and fiscal capital. The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates.

Education and Certification Qualifications of Departmentalized Public High School-Level Teachers of Selected Subjects: Evidence from the 2011-12 Schools and Staffing Survey. NCES 2015-814

ERIC Educational Resources Information Center

Hill, Jason; Stearns, Christina

2015-01-01

This report examines the postsecondary majors and teaching certifications of public high school-level teachers of departmentalized classes in selected subject areas by using data from the 2011-12 Schools and Staffing Survey (SASS), a sample survey of elementary and secondary schools in the United States. SASS collects data on American public and…

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 nursing WPTs, and practical guidance for nurse managers. CRD42016038132. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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…

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.

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

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

Should I stay or should I go? The influence of individual and organizational factors on pharmacists' future work plans.

PubMed

Gaither, Caroline A; Nadkarni, Anagha; Mott, David A; Schommer, Jon C; Doucette, William R; Kreling, David H; Pedersen, Craig A

2007-01-01

To examine the association between individual (demographic) and organizational (work environment and workload) factors and pharmacists' future work plans and explore reasons for either leaving or staying with current employers (culture/climate factors). Cross-sectional study. United States in 2004. 1,263 pharmacists. Seven-page mail survey. Future work plans, time spent in practice activities, staffing levels, and actual and perceived workload and demographic variables. Overall, 15% of respondents reported that they planned to leave their current employer within the year subsequent to this survey. More than 50% reported that their workload had significantly increased in the previous year. Multivariate analyses showed that nonwhites were 2.1 times more likely to be planning to leave their current employer, compared with whites, and unmarried respondents were 1.7 times more likely to leave than were married individuals. More negative perceptions regarding the impact of workload on various personal, work, and patient care outcomes predicted leaving. A main factor that prompted their inclinations was described by 72% of leavers (insufficient and/or unqualified staff) and 49% of stayers (flexible scheduling). The most common reasons for staying were good salary and relationships with coworkers, while the most common reasons for leaving were a desire for change and stress/workload issues. Future work plans of pharmacists are influenced by a variety of individual, organizational, and culture/climate factors. While employers have little latitude for influencing demographic characteristics of employees, many organizational and culture/climate factors (scheduling, opportunities for interpersonal interactions, salary/benefits, staffing, and workload) can be addressed with the intent of reducing pharmacist turnover.

Oregon School-Based Health Centers, 1992-1994 Services Report.

ERIC Educational Resources Information Center

Nystrom, Robert J.

This report describes the activities of Oregon's 25 high school-based health centers between 1992 and 1994. Information is provided on funding sources, services offered (including general medical services and reproductive health, mental health, health promotion services, and hours of operation), staffing (including levels of staffing and…

School Library Renaissance in Baltimore County: An Open-and-Shut Case for Library Funding.

ERIC Educational Resources Information Center

Curtis, Della

2000-01-01

Explains how Baltimore County secondary school libraries increased their funding and staffing levels. Discusses a partnership with Towson University for staffing needs; the role of technology; the development of online learning modules; marketing efforts; state standards for library collections; and collection analysis criteria. (LRW)

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.

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.

Analysing "IJAD," and Some Pointers to Futures for Academic Development (and for "IJAD")

ERIC Educational Resources Information Center

Baume, David

2016-01-01

This paper starts by sketching "International Journal for Academic Development (IJAD's)" first 20 years, its contents and concerns and staffing. Suggestions follow on future directions for both research and practice in academic development. These suggestions build in particular, but not exclusively, on reviews of and projections for…

Education and Certification Qualifications of Departmentalized Public High School-Level Teachers of Core Subjects: Evidence from the 2007-08 Schools and Staffing Survey. Statistical Analysis Report. NCES 2011-317

ERIC Educational Resources Information Center

Hill, Jason G.

2011-01-01

This report examines the postsecondary majors and teaching certifications of public high school-level teachers of departmentalized classes in a selection of subject areas by using data from the 2007-08 Schools and Staffing Survey (SASS), a sample survey of elementary and secondary schools in the United States. SASS collects data on American…

The Relationships Among Licensed Nurse Turnover, Retention, and Rehospitalization of Nursing Home Residents

PubMed Central

Thomas, Kali S.

2013-01-01

Purpose: Individuals receiving postacute care in skilled nursing facilities often require complex, skilled care provided by licensed nurses. It is believed that a stable set of nursing personnel is more likely to deliver better care. The purpose of this study was to determine the relationships among licensed nurse retention, turnover, and a 30-day rehospitalization rate in nursing homes (NHs). Design and Methods: We combined two data sources: NH facility-level data (including characteristics of the facility, the market, and residents) and the Florida Nursing Home Staffing Reports (which provide staffing information for each NH) for 681 Florida NHs from 2002 to 2009. Using a two-way fixed effects model, we examined the relationships among licensed nurse turnover rates, retention rates, and 30-day rehospitalization rates. Results: Results indicate that an NH’s licensed nurse retention rate is significantly associated with the 30-day rehospitalization rate (est. = −.02, p = .04) controlling for demographic characteristics of the patient population, residents’ preferences for hospitalization, and the ownership characteristics of the NH. The NHs experiencing a 10% increase in their licensed nurse retention had a 0.2% lower rehospitalization rate, which equates to 2 fewer hospitalizations per NH annually. Licensed nurse turnover is not significantly related to the 30-day rehospitalization rate. Implications: These findings highlight the need for NH administrators and policy makers to focus on licensed nurse retention, and future research should focus on the measures of staff retention for understanding the staffing/quality relationship. PMID:22936529

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.

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 terms of enhanced authority and autonomy. The perceived subservient position of nurses in the hospital appears to be the root cause of nurse staffing problems. It is yet unknown whether an objective PCS to measure nursing care intensity would help them communicate effectively and credibly, thereby improving their own position. Copyright © 2015 Elsevier Ltd. All rights reserved.

Uncertainty and operational considerations in mass prophylaxis workforce planning.

PubMed

Hupert, Nathaniel; Xiong, Wei; King, Kathleen; Castorena, Michelle; Hawkins, Caitlin; Wu, Cindie; Muckstadt, John A

2009-12-01

The public health response to an influenza pandemic or other large-scale health emergency may include mass prophylaxis using multiple points of dispensing (PODs) to deliver countermeasures rapidly to affected populations. Computer models created to date to determine "optimal" staffing levels at PODs typically assume stable patient demand for service. The authors investigated POD function under dynamic and uncertain operational environments. The authors constructed a Monte Carlo simulation model of mass prophylaxis (the Dynamic POD Simulator, or D-PODS) to assess the consequences of nonstationary patient arrival patterns on POD function under a variety of POD layouts and staffing plans. Compared are the performance of a standard POD layout under steady-state and variable patient arrival rates that may mimic real-life variation in patient demand. To achieve similar performance, PODs functioning under nonstationary patient arrival rates require higher staffing levels than would be predicted using the assumption of stationary arrival rates. Furthermore, PODs may develop severe bottlenecks unless staffing levels vary over time to meet changing patient arrival patterns. Efficient POD networks therefore require command and control systems capable of dynamically adjusting intra- and inter-POD staff levels to meet demand. In addition, under real-world operating conditions of heightened uncertainty, fewer large PODs will require a smaller total staff than many small PODs to achieve comparable performance. Modeling environments that capture the effects of fundamental uncertainties in public health disasters are essential for the realistic evaluation of response mechanisms and policies. D-PODS quantifies POD operational efficiency under more realistic conditions than have been modeled previously. The authors' experiments demonstrate that effective POD staffing plans must be responsive to variation and uncertainty in POD arrival patterns. These experiments highlight the need for command and control systems to be created to manage emergency response successfully.

Pediatric intensive care unit admission tool: a colorful approach.

PubMed

Biddle, Amy

2007-12-01

This article discusses the development, implementation, and utilization of our institution's Pediatric Intensive Care Unit (PICU) Color-Coded Admission Status Tool. Rather than the historical method of identifying a maximum number of staffed beds, a tool was developed to color code the PICU's admission status. Previous methods had been ineffective and led to confusion between the PICU leadership team and the administration. The tool includes the previously missing components of staffing and acuity, which are essential in determining admission capability. The PICU tool has three colored levels: green indicates open for admissions; yellow, admission alert resulting from available beds or because staffing is not equal to the projected patient numbers or required acuity; and red, admissions on hold because only one trauma or arrest bed is available or staffing is not equal to the projected acuity. Yellow and red designations require specific actions and the medical director's approval. The tool has been highly successful and significantly impacted nursing with the inclusion of the essential component of nurse staffing necessary in determining bed availability.

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.

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

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.

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.

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 significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. Improving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested. Copyright © 2015 Elsevier Ltd. All rights reserved.

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…

Measuring the Impact of High School Counselors on College Enrollment. Research Brief

ERIC Educational Resources Information Center

Hurwitz, Michael; Howell, Jessica

2013-01-01

This brief examines high school counselor staffing counts relative to four-year college enrollment rates. Recent evidence from a national survey of counselors provides support for claims by counselors and school administrators that current counselor staffing levels are suboptimal. An additional high school counselor is predicted to induce a 10…

Renal in-patient ward nurse experience and job satisfaction: A qualitative study.

PubMed

McKenzie, Aisha Tamika; Addis, Gulen

2018-06-13

The aim of this study was to examine the experience of registered nurses working in renal inpatients wards at an acute National Health Service (NHS) hospital Trust. Nurse perceptions of their experience particularly in relation to job satisfaction was analysed. Increased understanding of workplace organisation and culture can contribute to improved nurse work experience and better patient care. Worldwide many studies conducted on nurse experience and job satisfaction show that job satisfaction level varies across work settings so analysis of job satisfaction at a local level such as in a ward is important for producing useful analysis and recommendations. Using purposive sampling, semi structured individual interviews were conducted on twelve registered nurses working on renal inpatient wards. The study identified three themes: safe care, organisational culture and work environment. Although staffing was identified as a key element to providing safe care maintaining adequate staffing levels remained a challenge. Whilst there were opportunities for professional development more support is needed for newly qualified nurses. Findings highlighted that renal patients were complex. It is important to maintain adequate staffing levels. Good clinical leadership is required to support and develop the positive experience of nurses. The high turnover of newly qualified nurses is a particular problem and nurse managers need to develop strategies to retain such nurses. Regular audits on staffing levels as part of improving workforce planning and patient safety need to be conducted. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The Latest Forecast.

ERIC Educational Resources Information Center

Laurence, David

2002-01-01

Discusses the "latest forecast" for the future of English departments. Addresses departmental and institutional staffing practices, employment opportunities for PhDs, the acceleration of change in the institution, and the general state of the study and teaching of English. (RS)

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.

Utilizing Technology to Examine the Impacts of Academic Program Plans on Faculty Staffing Levels. AIR 1984 Annual Forum Paper.

ERIC Educational Resources Information Center

Spiro, Louis M.; Campbell, Jill F.

The development and use of a campus-based computerized faculty staffing model is described. In addition to considering market demands for current and proposed programs, decisionmakers need to consider how program development, modification, and elimination affect the total college faculty resource base. The application of computer technology,…

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…

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…

APPA's New Operational Guidelines for Educational Facilities

ERIC Educational Resources Information Center

Bigger, Alan S.

2011-01-01

Nearly 25 years ago a group of APPA members and facilities managers started to discuss an idea and to plant a seed about the need for a document, or series of documents, that would explain the need for staffing facilities operations and the implication of such staffing on levels of service. As the demand for increased budget cuts reached seismic…

Correlates and predictors of missed nursing care in hospitals.

PubMed

Bragadóttir, Helga; Kalisch, Beatrice J; Tryggvadóttir, Gudný Bergthora

2017-06-01

To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. This was a quantitative cross-sectional survey study. The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March-April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. Missed nursing care was significantly related to hospital and unit type, participants' age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested. © 2016 John Wiley & Sons Ltd.

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.

CDDIS Data Center Summary for the 2004 IVS Annual Report

NASA Technical Reports Server (NTRS)

Noll, Carey

2005-01-01

This report summarizes activities during the year 2004 and future plans of the Crustal Dynamics Data Information System (CDDIS) with respect to the International VLBI service for Geodesy and Astrometry (IVS). Included in this report are background information about the CDDIS, the computer architecture, staffing the support system, archive contents, and future plans for the CDDIS within the IVS.

CDDIS Data Center Summary for the 2003 IVS Annual Report

NASA Technical Reports Server (NTRS)

Noll, Carey

2004-01-01

This report summarizes activities during the year 2003 and future plans of the Crustal Dynamics Data Information System (CDDIS) with respect to the International VLBI Service for Geodesy and Astrometry (IVS). Included in this report are background information about the CDDIS, the computer architecture, staffing supporting the system, archive contents, and future plans for the CDDIS within the IVS.

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.

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.

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.

American Society of Clinical Oncology National Census of Oncology Practices: Preliminary Report

PubMed Central

Forte, Gaetano J.; Hanley, Amy; Hagerty, Karen; Kurup, Anupama; Neuss, Michael N.; Mulvey, Therese M.

2013-01-01

In response to reports of increasing financial and administrative burdens on oncology practices and a lack of systematic information related to these issues, American Society of Clinical Oncology (ASCO) leadership started an effort to collect key practice-level data from all oncology practices in the United States. The result of the effort is the ASCO National Census of Oncology Practices (Census) launched in June 2012. The initial Census work involved compiling an inventory of oncology practices from existing lists of oncology physicians in the United States. A comprehensive, online data collection instrument was developed, which covered a number of areas, including practice characteristics (staffing configuration, organizational structure, patient mix and volume, types of services offered); organizational, staffing, and service changes over the past 12 months; and an assessment of the likelihood that the practice would experience organizational, staffing, and service changes in the next 12 months. More than 600 practices participated in the Census by providing information. In this article, we present preliminary highlights from the data gathered to date. We found that practice size was related to having experienced practice mergers, hiring additional staff, and increasing staff pay in the past 12 months, that geographic location was related to having experienced hiring additional staff, and that practices in metropolitan areas were more likely to have experienced practice mergers in the past 12 months than those in nonmetropolitan areas. We also found that practice size and geographic location were related to higher likelihoods of anticipating practice mergers, sales, and purchases in the future. PMID:23633966

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.

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.

The Impact of Part-Time Staff on Art & Design Students' Ratings of Their Programmes

ERIC Educational Resources Information Center

Yorke, Mantz

2014-01-01

Art & Design receives ratings on a number of scales of the UK's National Student Survey (NSS) that are less strong than those for some other subject areas. Art & Design, along with performing arts, is characterised by a relatively high level of part-time (PT) staffing. PT staffing data are set against NSS ratings for post-92 universities…

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…

Targeted Support and Telecare in Staffed Housing for People with Intellectual Disabilities: Impact on Staffing Levels and Objective Lifestyle Indicators

ERIC Educational Resources Information Center

Perry, Jonathan; Firth, Caroline; Puppa, Michael; Wilson, Rick; Felce, David

2012-01-01

Background: Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of…

Local health department 2009 H1N1 influenza vaccination clinics-CDC staffing model comparison and other best practices.

PubMed

Porter, Dayna; Hall, Mark; Hartl, Brian; Raevsky, Cathy; Peacock, Roberta; Kraker, David; Walls, Sandra; Brink, Gail

2011-01-01

Mass vaccination clinic staffing models, such as the Centers for Disease Control and Prevention Large-Scale Vaccination Clinic Output and Staff Estimates: An Example, provide guidance on appropriate roles and number of staff for successful mass vaccination clinics within local and state health departments. The Kent County Health Department used this model as a starting point for mass vaccination clinics in response to 2009 H1N1 influenza. In addition to discussion of successful modification of the Centers for Disease Control and Prevention model to maximize local health department mass vaccination clinic efficiency, additional best practices including use of the Incident Command System and a reservation system are provided. Use of the provided modified staffing model and additional best practices will increase the success of health department mass vaccination clinics, and should be considered not only for future public health emergencies, but also for seasonal influenza vaccination campaigns.

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.

Baccalaureate education in nursing and patient outcomes.

PubMed

Blegen, Mary A; Goode, Colleen J; Park, Shin Hye; Vaughn, Thomas; Spetz, Joanne

2013-02-01

The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals, analyzed the association between RN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

Back to Basics.

ERIC Educational Resources Information Center

May, Abigail

1998-01-01

Offers some key business principles with the hope of helping educational facilities managers improve their operations. Looks at customer service, disparate databases, technological concerns, the mission of facility management, how to improve the bottom line, staffing ideas, future planning, and management suggestions. Lists seven habits of…

Looking for a Few Good Librarians.

ERIC Educational Resources Information Center

Everhart, Nancy

2000-01-01

Discusses the impending shortage of school librarians. Topics include state hiring mandates that don't require certified media specialists; certified library personnel shortages; staffing ratios; support staff; access to library education programs, including distance education via the Internet; and future concerns. (LRW)

Nursing workforce planning: insights from seven Malaysian hospitals.

PubMed

Drake, Robert

In 2010, the Royal College of Nursing asked: 'What is the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible?' This question implies there is a relationship between staffing levels, quality of care and financial efficiency. This paper examines the relationship between the staff budget, the number of staff required to achieve a target level of care and the actual number of staff employed in seven hospitals in Malaysia. It seeks to critically evaluate local challenges arising from staff budgeting/planning procedures, identify general issues that apply beyond Malaysian healthcare institutions and, finally, to propose a model that combines finance, staffing and level of care.

Different Levels of Leadership for Learning: Investigating Differences between Teachers Individually and Collectively Using Multilevel Factor Analysis of the 2011-2012 Schools and Staffing Survey

ERIC Educational Resources Information Center

Boyce, Jared; Bowers, Alex J.

2018-01-01

This study investigated the differences between how individual teachers perceive leadership for learning and how teachers collectively perceive leadership for learning, using a large nationally generalizable data-set of 7070 schools from the National Center for Education Statistics 2011-2012 Schools and Staffing Survey. This study used…

An approach to radiation safety department benchmarking in academic and medical facilities.

PubMed

Harvey, Richard P

2015-02-01

Based on anecdotal evidence and networking with colleagues at other facilities, it has become evident that some radiation safety departments are not adequately staffed and radiation safety professionals need to increase their staffing levels. Discussions with management regarding radiation safety department staffing often lead to similar conclusions. Management acknowledges the Radiation Safety Officer (RSO) or Director of Radiation Safety's concern but asks the RSO to provide benchmarking and justification for additional full-time equivalents (FTEs). The RSO must determine a method to benchmark and justify additional staffing needs while struggling to maintain a safe and compliant radiation safety program. Benchmarking and justification are extremely important tools that are commonly used to demonstrate the need for increased staffing in other disciplines and are tools that can be used by radiation safety professionals. Parameters that most RSOs would expect to be positive predictors of radiation safety staff size generally are and can be emphasized in benchmarking and justification report summaries. Facilities with large radiation safety departments tend to have large numbers of authorized users, be broad-scope programs, be subject to increased controls regulations, have large clinical operations, have significant numbers of academic radiation-producing machines, and have laser safety responsibilities.

Flexibility as a management principle in dementia care: the Adards example.

PubMed

Cohen-Mansfield, Jiska; Bester, Allan

2006-08-01

Flexibility is an essential ingredient of person-centered care. We illustrate the potential impact of flexibility by portraying a nursing home that uses flexibility in its approach to residents and staff members. The paper describes the management strategies, principles, and environmental features used by the Adards nursing home in Australia. Adards' flexibility in daily work and task scheduling promotes both resident and staff autonomy, which in turn allows for higher staffing levels, lower staff turnover, and more typical life experiences for residents than is found in many long-term-care facilities in the United States. The article provides an example and a basis for future discussion on this topic, with the hope that it will prompt other institutions to expand the level of flexibility in their policies and procedures.

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...

The European Federation of Organisations for Medical Physics. Policy Statement No. 7.1: The roles, responsibilities and status of the medical physicist including the criteria for the staffing levels in a Medical Physics Department approved by EFOMP Council on 5th February 2016.

PubMed

Evans, Stephen; Christofides, Stelios; Brambilla, Marco

2016-04-01

This EFOMP Policy Statement is an amalgamation and an update of the EFOMP Policy Statements No. 2, 4 and 7. It presents guidelines for the roles, responsibilities and status of the medical physicist together with recommended minimum staffing levels. These recommendations take into account the ever-increasing demands for competence, patient safety, specialisation and cost effectiveness of modern healthcare services, the requirements of the European Union Council Directive 2013/59/Euratom laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation, the European Commission's Radiation Protection Report No. 174: "Guidelines on medical physics expert", as well as the relevant publications of the International Atomic Energy Agency. The provided recommendations on minimum staffing levels are in very good agreement with those provided by both the European Commission and the International Atomic Energy Agency. Copyright © 2016. Published by Elsevier Ltd.

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 nursing assistants on patient outcomes is very limited. However, it is suggested that specialist support staff, such as dietary assistants, may have an important impact on patient outcomes. Self-scheduling and primary nursing may reduce staff turnover. The introduction of team midwifery (versus standard care) may reduce medical procedures in labour and result in a shorter length of stay without compromising maternal or perinatal safety. We found no eligible studies of educational interventions, grade mix interventions, or staffing levels and therefore we are unable to draw conclusions in relation to these interventions. The findings suggest interventions relating to hospital nurse staffing models may improve some patient outcomes, particularly the addition of specialist nursing and specialist support roles to the nursing workforce. Interventions relating to hospital nurse staffing models may also improve staff-related outcomes, particularly the introduction of primary nursing and self-scheduling. However, these findings should be treated with extreme caution due to the limited evidence available from the research conducted to date.

Implications of Automation for Operating and Staffing an Advanced Air Traffic Management System

DOT National Transportation Integrated Search

1974-08-01

The role of the air traffic controller in future system operations is expected to be substantially affected by the introduction of new automated features. The number of human operators needed to man the system will almost certainly decrease as machin...

Who Will Teach? Experience Matters

ERIC Educational Resources Information Center

National Commission on Teaching and America's Future, 2010

2010-01-01

Working with Richard Ingersoll, professor of Education and Sociology at the University of Pennsylvania, the National Commission on Teaching and America's Future (NCTAF) examined and analyzed data from the "Schools and Staffing Survey" (SASS), the largest and most comprehensive source of data on teachers, gathered from a nationally…

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...

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. The real challenge will be to develop planning systems and implement corrective interventions such as dynamic and flexible daily staffing, which will face difficulties and barriers. The paper fulfils the need for workforce utilization evaluation. A simple method using available data for daily staffing appropriateness evaluation, which is easy to implement and operate, is presented. The statistical process control method enables intra-ward evaluation, while standardization by converting crude into relative measures enables inter-ward analysis. The staffing indicator definitions enable performance evaluation. This original study uses statistical process control to develop simple standardization methods and applies straightforward statistical tools. This method is not limited to crude measures, rather it uses weighted workload measures such as nursing acuity or weighted nurse level (i.e. grade/band).

Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set.

PubMed

Stifter, Janet; Yao, Yingwei; Lodhi, Muhammad Kamran; Lopez, Karen Dunn; Khokhar, Ashfaq; Wilkie, Diana J; Keenan, Gail M

2015-01-01

Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes. The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care data set containing 42,403 episodes documented by 787 nurses, on nine units, in four hospitals and includes nurse staffing and patient characteristics. The HANDS data set resides in a "big data" relational database consisting of 89 tables and 747 columns of data. Via data mining, we created an analytic data set of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the association of nurse continuity and additional nurse-staffing variables on HAPU occurrence. Poor nurse continuity (unit mean continuity index = .21-.42 [1.0 = optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission, as well as patient age, were associated with HAPUs (p < .001). Controlling for patient characteristics, nurse continuity, and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. We demonstrated a high level of variation in the degree of continuity between patient episodes in the HANDS data, showing that it offers rich potential for future study of nurse continuity and its effect on patient outcomes.

A cross-level investigation of informal field-based learning and performance improvements.

PubMed

Wolfson, Mikhail A; Tannenbaum, Scott I; Mathieu, John E; Maynard, M Travis

2018-01-01

Organizations often operate in complex and dynamic environments which place a premium on employees' ongoing learning and acquisition of new competencies. Additionally, the majority of learning in organizations does not take place in formal training settings, but we know relatively little about how informal field-based learning (IFBL) behaviors relate to changes in job performance. In this study, we first clarified the construct of IFBL as a subset of informal learning. Second, on the basis of this clarified construct definition, we developed a measure of IFBL behaviors and demonstrated its psychometric properties using (a) a sample of subject matter experts who made item content validity judgments and (b) both an Amazon Mechanical Turk sample (N = 400) and a sample of 1,707 healthcare employees. Third, we advanced a grounded theory of IFBL in healthcare, and related it to individuals' regulatory foci and contextual moderators of IFBL behaviors-job performance relationships using a cross-level design and lagged nonmethod bound measures. Specifically, using a sample of 407 healthcare workers from 49 hospital units, our results suggested that promotion-focused individuals, especially in well-staffed units, readily engage in IFBL behaviors. Additionally, we found that the IFBL-changes in job performance relationship was strengthened to the extent that individuals worked in units with relatively nonpunitive climates. Interestingly, staffing levels had a weakening moderating effect on the positive IFBL-performance improvements relationship. Detailed follow-up analyses revealed that the peculiar effect was attributable to differential relationships from IFBL subdimensions. Implications for future theory building, research, and practice are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Effectiveness and Need for Facility Based Nurse Aide Training Competency Evaluation Programs.

PubMed

Mileski, Michael; McIlwain, Amber S; Kruse, Clemens Scott; Lieneck, Cristian; Sokan, Amanda

2016-01-01

It has become crucial for nursing facilities to rapidly train future nurse aides and remove any barriers to their matriculation into the field of care. Facilities feel the organizational burden of insufficient staffing and need to lever all effective programs to train future employees. The facility-based, Nurse Aide Training Competency Evaluation Programs (NATCEP) serve as a viable option to help fill shortages in the professional medical workforce. Data were analyzed from the National Nursing Assistant Survey to provide an overview of the benefits of using facility-trained nurse aides, versus those trained elsewhere, including their own perceptions of training and abilities. These findings also show the importance of facility based training programs for nurse aides on a global level. Providing training on site increases the efficiency and proficiency of nurse aides, making the transition to caregivers an easier for students, employers and residents.

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 modify adequate nurse staffing levels and better work environments for nurses are needed to improve patient outcomes. © 2015 Sigma Theta Tau International.

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.

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

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.

The relationship of weekend admission and mortality on the public medical wards at a Kenyan referral hospital.

PubMed

Stone, Geren S; Aruasa, Wilson; Tarus, Titus; Shikanga, Mainard; Biwott, Benson; Ngetich, Thomas; Andale, Thomas; Cheriro, Betsy

2015-11-01

Research has demonstrated disparities in the outcomes of patients admitted to hospital on weekends in high-income countries. No published research has evaluated if any similar discrepancy exists in low-resource settings. To determine if any difference in mortality exists between weekend and weekday admissions on the public medical wards at a Kenyan referral hospital, we performed a retrospective observational study of inpatients over a 3-month study period. During the study period, 261 (27.3%) of the 956 patients were admitted over the weekend. The mortality rates for patients admitted on weekends and weekdays did not differ with 156 (22.4%) of the 695 patients admitted on weekdays dying compared to 55 (21.1%) of the 261 patients admitted on weekends. After adjusting for age, insurance status, co-morbid illness, HIV status, employment, referral status and gender, still no association existed between weekend admission and mortality. Among adult patients on the medical wards, patients admitted on weekends had similar mortality rates to those admitted on weekdays. This similarity may reflect a stable level of care or a generalized shortage of resources and staffing that subsumes any impact of weekly variations. Future research examining optimal staffing and resource levels is needed in such settings. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings.

PubMed

Toh, Shir Gi; Ang, Emily; Devi, M Kamala

2012-06-01

To establish the best available evidence regarding the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings. Electronic databases (CINAHL, Medline, Scopus, ScienceDirect, PsycInfo, PsycArticles, Web of Science, The Cochrane Library, Proquest and Mednar) were searched using a three-step strategy in order to identify published and unpublished studies conducted between 1990 and 2010. Grey literature was excluded in the review. The identified studies were evaluated using standardised critical appraisal instruments from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). A total of seven descriptive and descriptive-correlational studies published in English were included and data were presented in a narrative summary. Findings revealed a positive bidirectional relationship between the nursing shortage and oncology registered nurses' (RNs') job dissatisfaction, stress and burnout. The extent of the job dissatisfaction, stress and burnout experienced by the oncology RNs and their perception of staffing inadequacy differed according to their demography and work settings. Particularly, nurses who had higher qualifications and positions, who worked full-time and who worked in inpatient settings and non-Magnet hospitals were more likely to attribute staffing inadequacy as one of the main contributing factors for their job dissatisfaction, stress and burnout. This led to a rise in the number of oncology RNs leaving the speciality. Within the constraints of the study and the few quality papers available, it appears that oncology RNs who worked in substandard staffing units often express job dissatisfaction, stress and burnout, which prompt them to seek new employment out of the oncology specialty. This entails a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to ensure that quality patient care is provided. Limited studies that examine the relationship between the nursing shortage and oncology RNs' stress and burnout have been conducted. Also, no studies in the Asian context have previously been conducted. Organizations need to customize their strategies for the recruitment and retention of oncology nurses. The strategies should take into consideration the specific demographic characteristics of oncology nurses or those of work settings that are experiencing staffing inadequacy and negative nursing outcomes. The strategies should also aim to replicate features of other institutions that are attractive to oncology nurses, and also include training that help oncology nurses better manage their emotions. Future research needs to examine the relationship between the nursing shortage and oncology nurses' job satisfaction, stress and burnout in bone marrow transplant units, paediatric oncology settings and Asian oncology settings. The characteristics of oncology nurses or workplaces that are more likely to experience negative nursing outcomes due the nursing shortage should also be identified. © 2012 The Authors. International Journal of Evidence-Based Healthcare © 2012 The Joanna Briggs Institute.

How to Manage an Extensive Laserdisk Installation: The Texas A&M Experience.

ERIC Educational Resources Information Center

Tucker, Sandra L.; And Others

1988-01-01

The second of two articles on the acquisition and implementation of a large laserdisk service at Texas A&M University covers equipment and supplies, future plans, service, staffing, training of staff and patrons, and statistics. A floor plan, user instruction sheet, and news release are included. (MES)

Distance Education and Virtual Reference: Where Are We Headed?

ERIC Educational Resources Information Center

Coffman, Steve

2001-01-01

Discusses changes in distance education and considers the resulting need for new types of library services. Topics include new Web-based contact center software; how to conduct virtual reference interviews; online reference service; the role of the physical library; staffing changes; and future possibilities, including impacts on costs of library…

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)

Rare Book and Manuscript Libraries in the Twenty-First Century.

ERIC Educational Resources Information Center

Wendorf, Richard, Ed.

Revised versions of the talks presented at the symposium are presented here. A preliminary discussion paper opens the manuscript, exploring the implications of changing patterns in teaching, research, and scholarship, the new demands of the marketplace and libraries' resultant collection development, the changing technologies, future staffing,…

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 terminology (e.g. by consistent use of the term "nurse staffing") could improve the precision of future searches in this field. Empirically selected search terms can help to develop effective search strategies. The high consistency between all test sets confirmed the validity of our approach. PMID:20731858

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 term "nurse staffing") could improve the precision of future searches in this field. Empirically selected search terms can help to develop effective search strategies. The high consistency between all test sets confirmed the validity of our approach.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

PubMed

Regan, Sandra; Wong, Carol; Laschinger, Heather K; Cummings, Greta; Leiter, Michael; MacPhee, Maura; Rhéaume, Ann; Ritchie, Judith A; Wolff, Angela C; Jeffs, Lianne; Young-Ritchie, Carol; Grinspun, Doris; Gurnham, Mary Ellen; Foster, Barbara; Huckstep, Sherri; Ruffolo, Maurio; Shamian, Judith; Burkoski, Vanessa; Wood, Kevin; Read, Emily

2017-05-01

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility. © 2017 John Wiley & Sons Ltd.

Formation of integrated structural units using the systematic and integrated method when implementing high-rise construction projects

NASA Astrophysics Data System (ADS)

Abramov, Ivan

2018-03-01

Development of design documentation for a future construction project gives rise to a number of issues with the main one being selection of manpower for structural units of the project's overall implementation system. Well planned and competently staffed integrated structural construction units will help achieve a high level of reliability and labor productivity and avoid negative (extraordinary) situations during the construction period eventually ensuring improved project performance. Research priorities include the development of theoretical recommendations for enhancing reliability of a structural unit staffed as an integrated construction crew. The author focuses on identification of destabilizing factors affecting formation of an integrated construction crew; assessment of these destabilizing factors; based on the developed mathematical model, highlighting the impact of these factors on the integration criterion with subsequent identification of an efficiency and reliability criterion for the structural unit in general. The purpose of this article is to develop theoretical recommendations and scientific and methodological provisions of an organizational and technological nature in order to identify a reliability criterion for a structural unit based on manpower integration and productivity criteria. With this purpose in mind, complex scientific tasks have been defined requiring special research, development of corresponding provisions and recommendations based on the system analysis findings presented herein.

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, the BBA contributed to the contemporaneous trends toward higher nurse workloads that could have deleterious effects on quality. In contrast, safety net hospitals did not respond to the provisions of the BBA by reducing staffing ratios. This conclusion is tempered by the fact that we have few safety net hospitals in the sample.

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.

Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces

DTIC Science & Technology

2011-09-02

manpower and staffing model for Physical Evaluation Board Liaison Officers (PEBLOs) and legal support. Ensure adequate PEBLO and legal staffing levels to...Function focus centrally on the restoration of the physical and mental health of the RW. In the trajectory toward recovery, rehabilitation, and...identified as going through the Medical Evaluation Board (MEB)/ Physical Evaluation Board (PEB) process,84 and a family liaison officer from the RW’s

Alternative Outpatient Chemotherapy Scheduling Method to Improve Patient Service Quality and Nurse Satisfaction.

PubMed

Huang, Yu-Li; Bryce, Alan H; Culbertson, Tracy; Connor, Sarah L; Looker, Sherry A; Altman, Kristin M; Collins, James G; Stellner, Winston; McWilliams, Robert R; Moreno-Aspitia, Alvaro; Ailawadhi, Sikander; Mesa, Ruben A

2018-02-01

Optimal scheduling and calendar management in an outpatient chemotherapy unit is a complex process that is driven by a need to focus on safety while accommodating a high degree of variability. Primary constraints are infusion times, staffing resources, chair availability, and unit hours. We undertook a process to analyze our existing management models across multiple practice settings in our health care system, then developed a model to optimize safety and efficiency. The model was tested in one of the community chemotherapy units. We assessed staffing violations as measured by nurse-to-patient ratios throughout the workday and at key points during treatment. Staffing violations were tracked before and after the implementation of the new model. The new model reduced staffing violations by nearly 50% and required fewer chairs to treat the same number of patients for the selected clinic day. Actual implementation results indicated that the new model leveled the distribution of patients across the workday with an 18% reduction in maximum chair utilization and a 27% reduction in staffing violations. Subsequently, a positive impact on peak pharmacy workload reduced delays by as much as 35 minutes. Nursing staff satisfaction with the new model was positive. We conclude that the proposed optimization approach with regard to nursing resource assignment and workload balance throughout a day effectively improves patient service quality and staff satisfaction.

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 physician staffing and mortality. © The Author(s) 2014.

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 contributes to the stable settlement of the long-term care insurance system for elders. © 2015 Sigma Theta Tau International.

75 FR 67769 - Amended Certification Regarding Eligibility To Apply for Worker Adjustment Assistance; Hartford...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... Services, Vantage Staffing, Volt Services Group, Adecco, Synergy Service Corp., and PDS Technical Services... Staffing Services, Vantage Staffing, Volt Services Group, Adecco, Synergy Service Corp., and PDS Technical... International, Aerotek, Professional Staffing Services, Vantage Staffing, Volt Services Group, Adecco, Synergy...

Preparing Marketing for the Future: Strategic Marketing Challenges for Continuing Education

ERIC Educational Resources Information Center

Fong, James

2013-01-01

Today's programs and delivery methods in continuing education for the adult student are evolving due to changing needs, competition, and new markets and technologies. The marketing infrastructure, including staffing, budgeting, and processes such as customer relationship marketing and market research, must be in alignment with changing needs.

Demographics: Diversity in More Forms. Student Demographics, Now and the Future.

ERIC Educational Resources Information Center

Windham, Patricia; And Others

While demographic diversity among the student body has increased substantially over the past several decades, the academic, economic, and social diversity of students will play a greater part in upcoming staffing and faculty requirements at community colleges. Data from Tallahassee Community College (TCC), in Florida, from 1980 to 1994 indicate…

Assessing the Therapeutic Environment in Hybrid Models of Treatment: Prisoner Perceptions of Staff

ERIC Educational Resources Information Center

Kubiak, Sheryl Pimlott

2009-01-01

Hybrid treatment models within prisons are staffed by both criminal justice and treatment professionals. Because these models may be indicative of future trends, examining the perceptions of prisoners/participants may provide important information. This study examines the perceptions of male and female inmates in three prisons, comparing those in…

A Profile of Public School Biology Teachers in the USA.

ERIC Educational Resources Information Center

Lindauer, Ivo E.; Queitzsch, Mary L.

1996-01-01

Uses data from the National Center for Educational Statistics' Schools and Staffing Survey (SASS) to present a profile of biology teachers. Discusses background of biology teachers, preparation in the physical and life sciences, who does the preparation, and expected future trends. Compares data with results reported for chemistry, earth science,…

The National Special Education Alliance: One Year Later.

ERIC Educational Resources Information Center

Green, Peter

1988-01-01

The National Special Education Alliance (a national network of local computer resource centers associated with Apple Computer, Inc.) consists, one year after formation, of 24 non-profit support centers staffed largely by volunteers. The NSEA now reaches more than 1000 disabled computer users each month and more growth in the future is expected.…

Reference Sources on CD-ROM at Indiana University.

ERIC Educational Resources Information Center

Bristow, Ann

1988-01-01

Describes the use of several CD-ROM products to provide access to reference sources in a large academic research library. Equipment and staffing problems and solutions, user reaction, and the impact of optical technologies on the library's fee-based searching service and planning for the future are discussed. (3 references) (Author/CLB)

Statement of National Environmental Health Assocation on Future National Health Legislation

ERIC Educational Resources Information Center

Pohlit, Nicholas; And Others

1974-01-01

This article concerns the need for more preventative health legislation to cutback increasing curative medical costs. Preventative action would provide better nutrition, better housing, and more effective controls on food, water, and solid wastes. Environmental health specialists would play a major role in the staffing of the new health systems.…

Staff Factors Contributing to Family Satisfaction with Long-Term Dementia Care: A Systematic Review of the Literature.

PubMed

Law, Katharine; Patterson, Tom G; Muers, Jane

2017-01-01

The aim of the present review was to critically evaluate empirical evidence regarding staff factors that contribute to families' satisfaction with ongoing care provision for their relatives with dementia in long-term care. Four databases were systematically searched using search terms informed by the aim of the present systematic review. The resulting 14 relevant articles comprised both qualitative and quantitative studies. The findings highlighted three broad areas relating to staff factors that appeared to contribute to families' satisfaction with care provision: family related factors, relating to staff interaction with families; staffing related factors, focusing on staffing organization and composition; and client related factors, focusing on staff interaction with clients and the quality of care provided. The findings have important implications for care staff and managers working in such settings regarding staffing organization, staff training, recruitment and retention. Future research directions are discussed. Families want consistent, knowledgeable staff that interact well and respond appropriately to the needs of their relative as well as their own needs as family members. Staff training in such settings should therefore focus not only on staff education but also on the importance of establishing effective relationships with both clients and families.

‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care

PubMed Central

Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter

2014-01-01

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215

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 attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels.

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. Supplemental interventions targeting attrition, graduation and public sector entry rates can help close the gap. HRH modelling can help MOH policy makers determine the relative priority and level of investment needed to expand Zambia's workforce to target staffing levels. PMID:20591143

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

Associations among state and local organizational contexts: Use of evidence-based practices in the criminal justice system.

PubMed

Henderson, Craig E; Young, Douglas W; Farrell, Jill; Taxman, Faye S

2009-08-01

This study used hierarchical linear modeling (HLM) to examine the extent to which the organizational characteristics of state corrections agencies and local criminal justice facilities interacted in their associations with the extent to which local facilities are using evidence-based substance abuse treatment practices (EBPs). The study used data collected from two nationally representative surveys - one of state executives and the other of local prison wardens, justice administrators, and treatment directors - which were conducted as part of the National Criminal Justice Treatment Practices survey [NCJTP; Taxman, F.S., Young, D., Wiersema, B., Mitchell, S., Rhodes, A.G., 2007. The National Criminal Justice Treatment Practices Survey: Multi-level survey methods and procedures. J. Subst. Abuse Treat. 32, 225-238], and includes both adult criminal and juvenile justice samples. Results indicated that several state organizational characteristics were either associated with more EBP use or interacted with local organizational characteristics in associations with EBP use, including: (1) systems integration at the state level was associated with greater EBP use; (2) state staffing adequacy and stability accentuated the association between local training and resources for new programs and EBP use (i.e., in states with better staffing, the relationship between training/resources and EBP use in local facilities was stronger); and (3) state executives' attitudes regarding the missions and goals of corrections tended to diminish the extent to which corresponding local administrator attitudes were associated with EBP use. The study has implications for future research focused on EBP diffusion and implementation in correctional environments, particularly attempts to influence EBP use by working through state agencies.

Staff satisfaction and retention and the role of the nursing unit manager.

PubMed

Duffield, Christine; Roche, Michael; O'Brien-Pallas, Linda; Catling-Paull, Christine; King, Madeleine

2009-01-01

Despite recent increases in nursing recruitment in Australia, participation in the workforce is still below the numbers predicted to meet future needs. This paper discusses factors impacting on nurses' job satisfaction, satisfaction with nursing and intention to leave in public sector hospitals in New South Wales (NSW), Australia. Staffing and patient data were collected on 80 medical and surgical units during 2004/5. This included a wide range of individual nurse data from a Nurse Survey; detailed and comprehensive staffing data including skill mix variables; patient characteristics; workload data; a profile of the ward's characteristics; and adverse event patient data. Nurses who were intending to remain in their job were more likely to be satisfied, be older, and have dependents. They were also likely to be experiencing good leadership and to have allied health support on the ward. Most nurses reported being satisfied with their profession, while a lower proportion reported satisfaction with their current position. Work environment factors such as nurses' autonomy, control over their practice and nursing leadership on the ward were statistically significant predictors of job satisfaction. This study will inform decision-making and policy for managers in both the public and private hospital sectors. This is the first large study which explored the work environment at the ward/unit level in public hospitals in NSW (Australia). It illustrates that there are no typical wards; each ward functions differently. The importance of nursing leadership at the ward level to job satisfaction, satisfaction with nursing and intention to leave, cannot be overstated.

Educational levels of hospital nurses and surgical patient mortality.

PubMed

Aiken, Linda H; Clarke, Sean P; Cheung, Robyn B; Sloane, Douglas M; Silber, Jeffrey H

2003-09-24

Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes. To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications). Cross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics. Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level. The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases). In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Hospital-Level Factors Associated with Pediatric Emergency Department Return Visits.

PubMed

Pittsenbarger, Zachary; Thurm, Cary; Neuman, Mark; Spencer, Sandra; Simon, Harold; Gosdin, Craig; Shah, Samir; McClead, Richard; Stack, Anne; Alpern, Elizabeth

2017-07-01

Return visits (RVs) and RVs with admission (RVAs) are commonly used emergency department quality measures. Visit- and patient-level factors, including several social determinants of health, have been associated with RV rates, but hospital-specific factors have not been studied. To identify what hospital-level factors correspond with high RV and RVA rates. Multicenter mixed-methods study of hospital characteristics associated with RV and RVA rates. Pediatric Health Information System with survey of emergency department directors. Adjusted return rates were calculated with generalized linear mixed-effects models. Hospitals were categorized by adjusted RV and RVA rates for analysis. Twenty-four hospitals accounted for 1,456,377 patient visits with an overall adjusted RV rate of 3.7% and RVA rate of 0.7%. Hospitals with the highest RV rates served populations that were more likely to have government insurance and lower median household incomes and less likely to carry commercial insurance. Hospitals in the highest RV rate outlier group had lower pediatric emergency medicine specialist staffing, calculated as full-time equivalents per 10,000 patient visits: median (interquartile range) of 1.9 (1.5-2.1) versus 2.9 (2.2-3.6). There were no differences in hospital population characteristics or staffing by RVA groups. RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care. © 2017 Society of Hospital Medicine

Restructuring in response to case mix reimbursement in nursing homes: A contingency approach

PubMed Central

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

2013-01-01

Background Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. Purpose The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. Methodology/Approach The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Findings Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Practice Implications Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring. PMID:18360162

Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

PubMed

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

2008-01-01

Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may become a factor influencing a range of decisions, including resident admission and staff hiring.

Improving Allocation And Management Of The Health Workforce In Zambia.

PubMed

Walsh, Fiona J; Musonda, Mutinta; Mwila, Jere; Prust, Margaret Lippitt; Vosburg, Kathryn Bradford; Fink, Günther; Berman, Peter; Rockers, Peter C

2017-05-01

Building a health workforce in low-income countries requires a focused investment of time and resources, and ministries of health need tools to create staffing plans and prioritize spending on staff for overburdened health facilities. In Zambia a demand-based workload model was developed to calculate the number of health workers required to meet demands for essential health services and inform a rational and optimized strategy for deploying new public-sector staff members to the country's health facilities. Between 2009 and 2011 Zambia applied this optimized deployment policy, allocating new health workers to areas with the greatest demand for services. The country increased its health worker staffing in districts with fewer than one health worker per 1,000 people by 25.2 percent, adding 949 health workers to facilities that faced severe staffing shortages. At facilities that had had low staffing levels, adding a skilled provider was associated with an additional 103 outpatient consultations per quarter. Policy makers in resource-limited countries should consider using strategic approaches to identifying and deploying a rational distribution of health workers to provide the greatest coverage of health services to their populations. Project HOPE—The People-to-People Health Foundation, Inc.

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.

People First: A New Zealand Approach to Staff, Structure and Service

ERIC Educational Resources Information Center

Hill, Jane

2007-01-01

This article uses Wellington City Libraries as the basis for a case study of a future-focused, reorganized staffing structure in a public library network. It covers the change from why, how, departure from a building-based hierarchical structure, new staff and line responsibilities, union involvement, implications for staff training to culture and…

The Path Forward: School Autonomy and Its Implications for the Future of Boston's Public Schools. Understanding Boston

ERIC Educational Resources Information Center

French, Dan; Hawley Miles, Karen; Nathan, Linda

2014-01-01

Boston Public Schools is at a crossroads. Nearly one-third of the system's schools operate under one of several "autonomy" structures, where school leaders have increased flexibility regarding staffing and other resources, and choice data indicate parents are far more likely to prefer these schools over so-called "traditional"…

Real World Project: Integrating the Classroom, External Business Partnerships and Professional Organizations

ERIC Educational Resources Information Center

Grant, Donna M.; Malloy, Alisha D.; Murphy, Marianne C.; Foreman, Jovanna; Robinson, Rowena A.

2010-01-01

A college degree is not what it used to be in respect to securing future employment. Constantly changing technologies in a struggling economy make it necessary for organizations to carefully balance recruitment staffing, particularly with regards to new hires. Organizations want to know that each new hire can add value immediately. In order to add…

Afternoon Delight. A Report of the APME P.M. Newspaper Committee.

ERIC Educational Resources Information Center

Associated Press Managing Editors.

Intended for newspaper managing editors, this collection of articles discusses the following topics: (1) prescriptions to keep America's P.M. dailies healthy and thriving, (2) pagination, (3) cable operations and videotext, (4) basic ways to insure the future of P.M. newspapers, (5) hawking newspapers, (6) staffing round-the-clock, (7) the growing…

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.

Business Case Analysis of the Walter Reed Army Medical Center Medical/Surgical Prime Vendor Generation III Service Level Electron Program

DTIC Science & Technology

2007-10-25

to the current staffing model and no changes or additions to PV contract services should be made. This scenario improves the division’s ability to...floater FTEs fully cross- trained in all areas should be added to the current staffing model and no changes or additions to PV services should be made...hospital’s average number of in-patients has dropped from about 700 to 200, as WRAMC follows the managed care model in civilian medicine that emphasizes

How much is not enough? Human resources requirements for primary health care: a case study from South Africa.

PubMed

Daviaud, Emmanuelle; Chopra, Mickey

2008-01-01

To quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. We use a model to estimate staffing requirements at primary health care facilities. The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility. We also calculate the number of HIV-related consultations per district. The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing. Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres. Overall the number of doctors is only 7% of the required amount. There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages. The number of enrolled nurses is 60% of what it should be. There are 17% too few enrolled nurse assistants. Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff. The application of an adapted WHO workload tool identified important human resource planning issues.

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.

Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe

PubMed Central

Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L.; Sloane, Douglas M.; Aiken, Linda H.; Sermeus, Walter

2015-01-01

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor’s degree reduce the effect of worse nurse staffing on more clinical care left undone. PMID:26062612

Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe.

PubMed

Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L; Sloane, Douglas M; Aiken, Linda H; Sermeus, Walter

2015-12-01

This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone. © The Author(s) 2015.

Nursing workload in the acute-care setting: A concept analysis of nursing workload.

PubMed

Swiger, Pauline A; Vance, David E; Patrician, Patricia A

2016-01-01

A pressing need in the field of nursing is the identification of optimal staffing levels to ensure patient safety. Effective staffing requires comprehensive measurement of nursing workload to determine staffing needs. Issues surrounding nursing workload are complex, and the volume of workload is growing; however, many workload systems do not consider the numerous workload factors that impact nursing today. The purpose of this concept analysis was to better understand and define nursing workload as it relates to the acute-care setting. Rogers' evolutionary method was used for this literature-based concept analysis. Nursing workload is influenced by more than patient care. The proposed definition of nursing workload may help leaders identify workload that is unnoticed and unmeasured. These findings could help leaders consider and identify workload that is unnecessary, redundant, or more appropriate for assignment to other members of the health care team. Published by Elsevier Inc.

Automation of Hubble Space Telescope Mission Operations

NASA Technical Reports Server (NTRS)

Burley, Richard; Goulet, Gregory; Slater, Mark; Huey, William; Bassford, Lynn; Dunham, Larry

2012-01-01

On June 13, 2011, after more than 21 years, 115 thousand orbits, and nearly 1 million exposures taken, the operation of the Hubble Space Telescope successfully transitioned from 24x7x365 staffing to 815 staffing. This required the automation of routine mission operations including telemetry and forward link acquisition, data dumping and solid-state recorder management, stored command loading, and health and safety monitoring of both the observatory and the HST Ground System. These changes were driven by budget reductions, and required ground system and onboard spacecraft enhancements across the entire operations spectrum, from planning and scheduling systems to payload flight software. Changes in personnel and staffing were required in order to adapt to the new roles and responsibilities required in the new automated operations era. This paper will provide a high level overview of the obstacles to automating nominal HST mission operations, both technical and cultural, and how those obstacles were overcome.

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.

A systematic review on the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings.

PubMed

Gi, Toh Shir; Devi, Kamala M; Neo Kim, Emily Ang

2011-01-01

Nursing shortage is a global issue that which affects oncology nursing. Oncology nurses are more prone to experience job dissatisfaction, stress and burnout when they work in units with poor staffing. There is thus a need for greater understanding of the relationship between the nursing shortage and nursing outcomes in oncology/haematology settings. This review aimed to establish the best available evidence concerning the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings; and to make recommendations for practice and future research. Types of participants: This review considered studies that included oncology registered nurses (RNs) who were more than 18 years of age and worked in either inpatient or outpatient oncology/haematology wards or units for the adult or paediatric patients.Types of intervention: This review considered studies that evaluated the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings.Types of outcomes: This review included studies that measured job satisfaction, stress and burnout levels using different outcomes measures. Job satisfaction was determined by the Measure of Job Satisfaction scale, the Misener Nurse Practitioner Job Satisfaction Scale and the Likert scale, stress by the Pediatric Oncology Nurse Stressor Questionnaire and burnout by the Maslash Burnout Inventory scale.Types of studies: This review included descriptive/descriptive-correlational studies which were published in English. The search strategy sought to identify published and unpublished studies conducted between 1990 and 2010. Using a three-step search strategy, the following databases were accessed: CINAHL, Medline, Scopus, ScienceDirect, PsycInfo, PsycArticles, Web of Science, The Cochrane Library, Proquest and Mednar. Two independent reviewers assessed each paper for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Disagreements were resolved through discussion, or with a third reviewer. Data were extracted using standardised data extraction tool adapted from the JBI-MAStARI. Data synthesisDue to the heterogeneous nature of the included papers, a meta-analysis was not possible. Hence, a narrative summary was presented for the studies. This review encompassed seven descriptive/descriptive-correlational studies. Findings revealed a positive bidirectional relationship between the nursing shortage and oncology nurses' job dissatisfaction, stress and burnout. In addition, the extent of oncology nurses' job dissatisfaction, stress and burnout, and their perception of staffing inadequacy also differed according to nurses' demography and work settings. The nursing shortage, coupled with an increasing number of patients diagnosed with cancer, entail a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to provide quality patient care. This then requires interventions that target both the recruitment and retention of nurses. Organisations need to customise their strategies for the recruitment and retention of oncology nurses. The strategies should take into considerations the specific demographic characteristics of oncology nurses or characteristics of work settings that are experiencing staffing inadequacy and negative nursing outcomes. The strategies should also aim to replicate features of other institutions that are attractive to oncology nurses; and also include training that help oncology nurses better manage their emotions. Future research need to examine the relationship between the nursing shortage and oncology nurses' job satisfaction, stress and burnout in bone marrow transplant units, paediatric oncology settings and also Asian oncology settings. Characteristics of oncology nurses or workplaces that are more likely to experience negative nursing outcomes due the nursing shortage should also be identified.

Strategies for addressing the evolving nursing crisis.

PubMed

2003-01-01

The shortage of registered nurses, which is already having ill effects on the U.S. health care delivery system, is burgeoning at a time when patient acuity is high, care is complex, and demand for services often exceeds capacity. This is a prescription for danger. Some hospitals fare better in recruiting and retaining nurses than others. Top-level managers who provide nurses with delegated authority, adequate staffing, competitive compensation, and a collaborative culture have a built-in resistance to cyclical nursing shortages--theirs is too good a place to work to leave. The shortage of nurses is mirrored by a corresponding shortage of nursing faculty. As nursing educator attrition continues, it is unclear where the future nursing school faculty will come from. Federal funding of nursing education is modest. Structured postgraduate training programs for nurses could provide an opportunity for skill building in real clinical settings. Although there is clearly a business case for creating a culture of nursing staff retention-based on lower turnover, lower costs, higher profitability, and better outcomes--there is just as clear a need for the investment of new dollars in hospitals to establish a new base of response capacity. For hospitals to be truly able to invest in nursing and to resolve the problems that have led to the impending nurse staffing crisis, new federal monies specifically targeted for nursing need to be made available.

25 CFR 163.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... systems. (k) Research activities to improve the basis for determining appropriate management measures to... current forestry funding and staffing levels; and standards providing quantitative criteria to evaluate...

25 CFR 163.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... systems. (k) Research activities to improve the basis for determining appropriate management measures to... current forestry funding and staffing levels; and standards providing quantitative criteria to evaluate...

25 CFR 163.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... systems. (k) Research activities to improve the basis for determining appropriate management measures to... current forestry funding and staffing levels; and standards providing quantitative criteria to evaluate...

25 CFR 163.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... systems. (k) Research activities to improve the basis for determining appropriate management measures to... current forestry funding and staffing levels; and standards providing quantitative criteria to evaluate...

25 CFR 163.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... systems. (k) Research activities to improve the basis for determining appropriate management measures to... current forestry funding and staffing levels; and standards providing quantitative criteria to evaluate...

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.

UK nuclear medicine survey, 1992-93.

PubMed

Elliott, A T; Elliott, F M; Shields, R A

1996-01-01

A postal survey of UK nuclear medicine departments was undertaken to collate information on equipment, numbers of procedures and staffing levels for the years 1992 and 1993. It was estimated that there are 235 sites undertaking nuclear medicine, the total number of procedures performed being some 490,000 in 1993 compared with 430,000 in 1989. Informal investigation suggests that the increase is due to greater usage of myocardial perfusion and lung ventilation/perfusion studies. Wide variations were noted in staffing levels, with only 22% of departments having medical cover of half-time equivalent or better: over 30% of departments have less than one consultant session per week. Approximately 20% of departments claimed to have no physics input, with a further 20% having less than one session per week.

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.

[A Survey of the Perception of Nurses Toward the Practice Environment at a Regional Teaching Hospital in Central Taiwan].

PubMed

Hung, Jui-Tai; Lin, Ching-Wen; Wen, Wei-Chun; Lin, Esther Ching-Lan

2015-08-01

The nursing practice environment has been shown to wield significant influence on nursing retention and nursing quality of care. Because a large percentage of Taiwan nurses currently work at regional teaching hospitals, exploring the perception toward the practice environment of nurses working at this type of hospital is important. This study explored the perception of nurses working at a regional teaching hospital in central Taiwan toward their practice environment. A cross-sectional research design with a sample of 474 nurses from a regional hospital in central Taiwan was conducted. Instruments including the demographic data and the Chinese-version Practice Environment Scale-Nursing Work Index (CPES-NWI) were anonymously self-administered. Overall, participants were moderately satisfied with their practice environment, with the greatest dissatisfaction focused on staffing and resource adequacy. Work unit and nursing level, respectively, had significant impacts on perceptions regarding the practice environment. Furthermore, discriminant analysis identified two new compound variables: 1) adequate staffing resources and partnership in the workplace and 2) supportive administrative management environment. Participants who worked in medical and surgical units were significantly more dissatisfied with the adequacy of staffing resources and partnership in the workplace than participants who worked in acute/intensive and special units. Participants at the N2 level were significantly more dissatisfied with the supportive nature of the administrative management environment. These findings support that the nursing practice environment of regional hospitals may be improved using several measures, including: modifying the staffing and resource adequacy of nurses, fostering collaborative nurse-physician relationships, and further involving nurses in administrative management and decision-making.

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…

Functional requirements for the man-vehicle systems research facility. [identifying and correcting human errors during flight simulation

NASA Technical Reports Server (NTRS)

Clement, W. F.; Allen, R. W.; Heffley, R. K.; Jewell, W. F.; Jex, H. R.; Mcruer, D. T.; Schulman, T. M.; Stapleford, R. L.

1980-01-01

The NASA Ames Research Center proposed a man-vehicle systems research facility to support flight simulation studies which are needed for identifying and correcting the sources of human error associated with current and future air carrier operations. The organization of research facility is reviewed and functional requirements and related priorities for the facility are recommended based on a review of potentially critical operational scenarios. Requirements are included for the experimenter's simulation control and data acquisition functions, as well as for the visual field, motion, sound, computation, crew station, and intercommunications subsystems. The related issues of functional fidelity and level of simulation are addressed, and specific criteria for quantitative assessment of various aspects of fidelity are offered. Recommendations for facility integration, checkout, and staffing are included.

Applying operations research to optimize a novel population management system for cancer screening.

PubMed

Zai, Adrian H; Kim, Seokjin; Kamis, Arnold; Hung, Ken; Ronquillo, Jeremiah G; Chueh, Henry C; Atlas, Steven J

2014-02-01

To optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations. TopCare was modeled as a multiserver, multiphase queueing system. Simulation experiments implemented the queueing network model following a next-event time-advance mechanism, in which systematic adjustments were made to staffing levels, IT workflow settings, and cancer screening frequency in order to assess their impact on overdue screenings per patient. TopCare reduced the average number of overdue screenings per patient from 1.17 at inception to 0.86 during simulation to 0.23 at steady state. Increases in the workforce improved the effectiveness of TopCare. In particular, increasing the delegate or navigator staff level by one person improved screening completion rates by 1.3% or 12.2%, respectively. In contrast, changes in the amount of time a patient entry stays on delegate and navigator lists had little impact on overdue screenings. Finally, lengthening the screening interval increased efficiency within TopCare by decreasing overdue screenings at the patient level, resulting in a smaller number of overdue patients needing delegates for screening and a higher fraction of screenings completed by delegates. Simulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management.

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.

The World Trade Center attack. Observations from New York's Bellevue Hospital.

PubMed

Roccaforte, J D

2001-12-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics.

Changes in the Staffing of UK Special Libraries and Information Services in the Decade 1972-81: A Review of the DES Census Data.

ERIC Educational Resources Information Center

East, Harry

1983-01-01

Presents information from Department of Education and Science bulletin summarizing "Census of Staff in Librarianship and Information Work in United Kingdom in 1981." Numbers of special libraries and staff, posts and qualifications, sex and age, job responsibilities, regionalism, and usefulness and future of census are noted. Seven…

General practitioners' experiences as nursing home medical consultants.

PubMed

Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

2017-03-01

To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

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...

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...

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...

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...

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...

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...

75 FR 54388 - Rain Bird Corporation, Arizona Molding Division Including On-Site Leased Workers From Lumea...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,762] Rain Bird Corporation, Arizona Molding Division Including On-Site Leased Workers From Lumea Staffing Services, Tri-State Staffing Services and Remedy Staffing (AKA Select Staffing) Tucson, AZ; Amended Certification Regarding Eligibility...

75 FR 20386 - Trane a Subsidiary of Ingersoll Rand Including On-Site Leased Workers From Aerotek, Express...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... Ingersoll Rand Including On-Site Leased Workers From Aerotek, Express Personnel Services, Select Staffing... Ingersoll Rand, including on-site leased workers from Aerotek, Express Personnel Staffing, and Select... from Aerotek, Express Personnel Staffing, Select Staffing, and Mechanical Contractors, Inc., Pueblo...

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.

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.

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.

The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management.

PubMed

Savel, Richard H; Cohen, Wess; Borgia, Dena; Simon, Ronald J

2018-01-01

The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care.

The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

PubMed Central

Savel, Richard H.; Cohen, Wess; Borgia, Dena; Simon, Ronald J.

2018-01-01

The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care. PMID:29628674

Advanced Nuclear Technology. Using Technology for Small Modular Reactor Staff Optimization, Improved Effectiveness, and Cost Containment, 3002007071

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

Loflin, Leonard

Through this grant, the U.S. Department of Energy (DOE) will review several functional areas within a nuclear power plant, including fire protection, operations and operations support, refueling, training, procurement, maintenance, site engineering, and others. Several functional areas need to be examined since there appears to be no single staffing area or approach that alone has the potential for significant staff optimization at new nuclear power plants. Several of the functional areas will require a review of technology options such as automation, remote monitoring, fleet wide monitoring, new and specialized instrumentation, human factors engineering, risk informed analysis and PRAs, component andmore » system condition monitoring and reporting, just in time training, electronic and automated procedures, electronic tools for configuration management and license and design basis information, etc., that may be applied to support optimization. Additionally, the project will require a review key regulatory issues that affect staffing and could be optimized with additional technology input. Opportunities to further optimize staffing levels and staffing functions by selection of design attributes of physical systems and structures need also be identified. A goal of this project is to develop a prioritized assessment of the functional areas, and R&D actions needed for those functional areas, to provide the best optimization« less

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.

A survey of the Australasian clinical medical physics and biomedical engineering workforce.

PubMed

Round, W H

2007-03-01

A survey of the medical physics and biomedical engineering workforce was carried out in 2006. 495 positions (equivalent to 478 equivalent full time (EFT) positions) were captured by the survey. Of these 268 EFT were in radiation oncology physics, 36 EFT were in radiology physics, 44 were in nuclear medicine physics, 101 EFT were in biomedical engineering and 29 EFT were attributed to other activities. The survey reviewed the experience profile, the salary levels and the number of vacant positions in the workforce for the different disciplines in each Australian state and in New Zealand. Analysis of the data identifies staffing shortfalls in the various disciplines and demonstrates the difficulties that will occur in trying to train sufficient physicists to raise staffing to an acceptable level.

USMC Identity Operations Strategy

DTIC Science & Technology

2011-01-01

safety, situational awareness and mission accomplishment • Action Officer Staffing – 2-4 November 2010 – USMC IdOps OIPT • MCATS Staffing – 21 December...10 March 2011 • Location: TBD – Enter into MCATS O-6/GS-15 Staffing – Late March 2011 – GO/SES Staffing – Early April 2011 – ACMC Signature – TBD 10

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";…

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…

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...

Defining Safety in the Nursing Home Setting: Implications for Future Research.

PubMed

Simmons, Sandra F; Schnelle, John F; Sathe, Nila A; Slagle, Jason M; Stevenson, David G; Carlo, Maria E; McPheeters, Melissa L

2016-06-01

Currently, the Agency for Healthcare Research and Quality (AHRQ) Common Format for nursing homes (NHs) accommodates voluntary reporting for 4 adverse events: falls with injury, pressure ulcers, medication errors, and infections. In 2015, AHRQ funded a technical brief to describe the state of the science related to safety in the NH setting to inform a research agenda. Thirty-six recent systematic reviews evaluated NH safety-related interventions to address these 4 adverse events and reported mostly mixed evidence about effective approaches to ameliorate them. Furthermore, these 4 events are likely inadequate to capture safety issues that are unique to the NH setting and encompass other domains related to residents' quality of care and quality of life. Future research needs include expanding our definition of safety in the NH setting, which differs considerably from that of hospitals, to include contributing factors to adverse events as well as more resident-centered care measures. Second, future research should reflect more rigorous implementation science to include objective measures of care processes related to adverse events, intervention fidelity, and staffing resources for intervention implementation to inform broader uptake of efficacious interventions. Weaknesses in implementation contribute to the current inconclusive and mixed evidence base as well as remaining questions about what outcomes are even achievable in the NH setting, given the complexity of most resident populations. Also related to implementation, future research should determine the effects of specific staffing models on care processes related to safety outcomes. Last, future efforts should explore the potential for safety issues in other care settings for older adults, most notably dementia care within assisted living. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Case-Mix and Quality Indicators in Chinese Elder Care Homes: Are There Differences between Government-owned and Private-sector Facilities?

PubMed Central

Liu, Chang

2015-01-01

Objective To assess the association between ownership of Chinese elder care facilities and their performance quality; and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Design Cross-sectional study. Setting Census of elder care homes surveyed in Nanjing (in 2009) and Tianjin (in 2010). Population 140 (or 95% of all) elder care facilities located in urban Nanjing, and 157 (or 97% of all) facilities in urban Tianjin. Main study outcome measures We created a summary case-mix index based on activities of daily living (ADL) limitations and cognitive impairment to measure levels of care needs among residents in each facility. We selected structure, process, and outcome measures to assess facility-level quality of care. We also developed a structural quality measure, under-staffing relative to residents’ levels of care needs, which indicates potentially inadequate staffing given the residents’ case-mix. Results Government-owned homes have significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but they serve residents who, on average, have fewer ADL and cognitive functioning limitations than do private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages to either ownership type. However, when staffing to resident ratio is gauged relative to residents’ case-mix, private-sector facilities were more likely to be under-staffed than government-owned facilities. Conclusions In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer, on average, than those in government facilities. The case-mix differences are likely the result of selective admission policies that favor relatively healthier residents in government facilities than in private-sector homes. PMID:24433350

Associations among state and local organizational contexts: Use of evidence-based practices in the criminal justice system

PubMed Central

Henderson, Craig E.; Young, Douglas W.; Farrell, Jill; Taxman, Faye S.

2016-01-01

This study used hierarchical linear modeling (HLM) to examine the extent to which the organizational characteristics of state corrections agencies and local criminal justice facilities interacted in their associations with the extent to which local facilities are using evidence-based substance abuse treatment practices (EBPs). The study used data collected from two nationally representative surveys – one of state executives and the other of local prison wardens, justice administrators, and treatment directors – which were conducted as part of the National Criminal Justice Treatment Practices survey [NCJTP; Taxman, F.S., Young, D., Wiersema, B., Mitchell, S., Rhodes, A.G., 2007. The National Criminal Justice Treatment Practices Survey: Multi-level survey methods and procedures. J. Subst. Abuse Treat. 32, 225–238], and includes both adult criminal and juvenile justice samples. Results indicated that several state organizational characteristics were either associated with more EBP use or interacted with local organizational characteristics in associations with EBP use, including: (1) systems integration at the state level was associated with greater EBP use; (2) state staffing adequacy and stability accentuated the association between local training and resources for new programs and EBP use (i.e., in states with better staffing, the relationship between training/resources and EBP use in local facilities was stronger); and (3) state executives’ attitudes regarding the missions and goals of corrections tended to diminish the extent to which corresponding local administrator attitudes were associated with EBP use. The study has implications for future research focused on EBP diffusion and implementation in correctional environments, particularly attempts to influence EBP use by working through state agencies. PMID:19174321

Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

PubMed

Toole, Cheryl A; DeGrazia, Michele; Connor, Jean Anne; Gauvreau, Kimberlee; Kuzdeba, Hillary Bishop; Hickey, Patricia A

Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.

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…

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...

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...

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...

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...

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.

Burnout Among Direct-Care Workers in Nursing Homes: Influences of Organizational, Work Place, Interpersonal, and Personal Characteristics.

PubMed

Yeatts, Dale E; Seckin, Gul; Shen, Yuying; Thompson, Michael; Auden, Dana; Cready, Cynthia M

2018-01-10

The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct care workers (DCWs) in nursing homes (NH). Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggest that there are many other factors also contributing to burnout. These range from those at the organizational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. A self-administered survey instrument was completed by 410 DCWs working within 11 NHs in the north Texas region. Regression analyses were performed, adjusting for clustering by NH. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Organizational, work design, interpersonal, and individual characteristics were found to be associated with one or more dimensions of burnout. The analyses largely support previous research. Organizational variables of significance included the availability of resources to do the work, available training, and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organization also had a large impact. While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support, and adequate training may result in less DCW burnout on the job. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The World Trade Center Attack: Observations from New York's Bellevue Hospital

PubMed Central

Roccaforte, J David

2001-01-01

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics. PMID:11737913

Diffusion of Evidence-based Intensive Care Unit Organizational Practices. A State-Wide Analysis.

PubMed

Kohn, Rachel; Madden, Vanessa; Kahn, Jeremy M; Asch, David A; Barnato, Amber E; Halpern, Scott D; Kerlin, Meeta Prasad

2017-02-01

Several intensive care unit (ICU) organizational practices have been associated with improved patient outcomes. However, the uptake of these evidence-based practices is unknown. To assess diffusion of ICU organizational practices across the state of Pennsylvania. We conducted two web-based, cross-sectional surveys of ICU organizational practices in Pennsylvania acute care hospitals, in 2005 (chief nursing officer respondents) and 2014 (ICU nurse manager respondents). Of 223 eligible respondents, nurse managers from 136 (61%) medical, surgical, mixed medical-surgical, cardiac, and specialty ICUs in 98 hospitals completed the 2014 survey, compared with 124 of 164 (76%) chief nursing officers in the 2005 survey. In 2014, daytime physician staffing models varied widely, with 23 of 136 (17%) using closed models and 33 (24%) offering no intensivist staffing. Nighttime intensivist staffing was used in 37 (27%) ICUs, 38 (28%) used nonintensivist attending staffing, and 24 (18%) had no nighttime attending physicians. Daily multidisciplinary rounds occurred in 93 (68%) ICUs. Regular participants included clinical pharmacists in 68 of 93 (73%) ICUs, respiratory therapists in 62 (67%), and advanced practitioners in 37 (39%). Patients and family members participated in rounds in 36 (39%) ICUs. Clinical protocols or checklists for mechanically ventilated patients were available in 128 of 133 (96%) ICUs, low tidal volume ventilation for acute respiratory distress syndrome in 54 of 132 (41%) ICUs, prone positioning for severe acute respiratory distress syndrome in 37 of 134 (28%) ICUs, and family meetings in 19 of 134 (14%) ICUs. Among 61 ICUs that responded to both surveys, there was a significant increase in the proportion of ICUs using nighttime in-ICU attending physicians (23 [38%] in 2005 vs. 30 [49%] in 2014; P = 0.006). The diffusion of evidence-based ICU organizational practices has been variable across the state of Pennsylvania. Only half of Pennsylvania ICUs have intensivists dedicated to the ICU. Variable numbers use clinical protocols for life-saving therapies, and few use structured family engagement strategies. In contrast, the diffusion of non-evidence-based practices, including overnight ICU attending physician staffing, is increasing. Future research should focus on promoting implementation of organizational evidence to promote high-quality ICU care.

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)

Longitudinal associations of nursing staff turnover with patient outcomes in long-term care hospitals in Korea.

PubMed

Kim, Yoonseo; Han, Kihye

2018-01-10

To describe the characteristics of long-term care hospitals in 2010-2013 and to examine the longitudinal associations of nursing staff turnover with patient outcomes. The number of long-term care hospitals has exploded in Korea since the national long-term care insurance was launched in 2008. The care quality deviation across long-term care hospitals is large. This was a longitudinal secondary data analysis using the Health Insurance Review and Assessment Service's data. From 2010 to 2013, the nursing staff turnover rate decreased. The number of patients per registered nurse increased while that per total nursing staff and skill mix decreased. All adverse patient outcomes decreased. Higher nursing staff turnover and lower RN proportions were associated with adverse patient outcomes. Since the launch of the long-term care insurance, total nursing staffing, turnover rate and patient outcomes have improved, while the skill mix has decreased. Systematic efforts to decrease nursing staff turnover should be implemented for better long-term care patient outcomes. In addition to maintaining high levels of nurse staffing and skill mix, supportive work environments and competitive wages and benefits could reduce turnover, and ultimately adverse patient outcomes. Health care policy should separate nursing staffing levels for registered nurses and certified nursing assistants. © 2018 John Wiley & Sons Ltd.

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

National Environmental/Energy Workforce Assessment for California.

ERIC Educational Resources Information Center

National Field Research Center Inc., Iowa City, IA.

This report presents existing workforce levels, training programs and career potentials and develops staffing level projections (1976-1982) based on available information for the State of California. The study concerns itself with the environmental pollution control areas of air, noise, potable water, pesticides, radiation, solid waste,…

National Environmental/Energy Workforce Assessment for Region IX.

ERIC Educational Resources Information Center

National Field Research Center Inc., Iowa City, IA.

This report represents a detailed summation of existing workforce levels, training programs, career potential, and staffing level projections through 1981 for EPA Region IX. This region serves the states of Arizona, California, Hawaii, and Nevada. The specific pollution programs considered include air, noise, pesticides, potable water, radiation…

Facility and market factors affecting transitions from nursing home to community.

PubMed

Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa

2011-09-01

Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.

Applying operations research to optimize a novel population management system for cancer screening

PubMed Central

Zai, Adrian H; Kim, Seokjin; Kamis, Arnold; Hung, Ken; Ronquillo, Jeremiah G; Chueh, Henry C; Atlas, Steven J

2014-01-01

Objective To optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations. Materials and methods TopCare was modeled as a multiserver, multiphase queueing system. Simulation experiments implemented the queueing network model following a next-event time-advance mechanism, in which systematic adjustments were made to staffing levels, IT workflow settings, and cancer screening frequency in order to assess their impact on overdue screenings per patient. Results TopCare reduced the average number of overdue screenings per patient from 1.17 at inception to 0.86 during simulation to 0.23 at steady state. Increases in the workforce improved the effectiveness of TopCare. In particular, increasing the delegate or navigator staff level by one person improved screening completion rates by 1.3% or 12.2%, respectively. In contrast, changes in the amount of time a patient entry stays on delegate and navigator lists had little impact on overdue screenings. Finally, lengthening the screening interval increased efficiency within TopCare by decreasing overdue screenings at the patient level, resulting in a smaller number of overdue patients needing delegates for screening and a higher fraction of screenings completed by delegates. Conclusions Simulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management. PMID:24043318

75 FR 22838 - Cape Romain National Wildlife Refuge, Charleston County, SC

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... opportunities for hunting, fishing, wildlife observation, wildlife photography, and environmental education and... additional elementary schools, students, and teachers. The refuge would be staffed at current levels plus the...

A Tangled Web: The Challenges of Implementing an Evidence-Based Social Engagement Intervention for Children With Autism in Urban Public School Settings

PubMed Central

Locke, Jill; Olsen, Anne; Wideman, Rukiya; Downey, Margaret Mary; Kretzmann, Mark; Kasari, Connie; Mandell, David S.

2015-01-01

There is growing evidence that efficacious autism-related interventions rarely are adopted or successfully implemented in public schools, in part because of the lack of fit between the intervention and the needs and capacities of the school setting. There is little systematic information available regarding the barriers to implementation of complex interventions such as those addressing social engagement for children with autism. The present study used fieldnotes from an implementation trial to explore barriers that emerged during the training of school personnel and subsequent implementation of a social engagement intervention. A number of barriers at the individual (training) and school levels (policies surrounding recess, staffing, prioritization of competing demands, level of respect and support, and availability of resources) interfered with the continued use and sustainment of the intervention. We offer potential strategies to overcome these barriers and provide directions for future research in this critical area. PMID:25526835

Barriers to physical activity and restorative care for residents in long-term care: a review of the literature.

PubMed

Benjamin, Kathleen; Edwards, Nancy; Ploeg, Jenny; Legault, Frances

2014-01-01

Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002-2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents living in LTC are needed to address these multiple levels of influence.

Engaging, recruiting, and retaining black men who have sex with men in research studies: don't underestimate the importance of staffing--lessons learned from HPTN 061, the BROTHERS study.

PubMed

Magnus, Manya; Franks, Julie; Griffith, Sam; Arnold, Michael P; Goodman, Krista; Wheeler, Darrell P

2014-01-01

HIV/AIDS in the United States continues to primarily impact men who have sex with men (MSM), with disproportionately high rates among black MSM. The purpose of this study was to identify factors that may influence engagement and retention of black MSM in HIV research. This was a qualitative evaluation of study implementation within a multisite, prospective, observational study (HIV Prevention Trials Network 061, BROTHERS) that enrolled 1553 black MSM in 6 cities throughout the United States. Data collection for this evaluation included a written, structured survey collected from each of the sites describing site characteristics including staff and organizational structure, reviews of site standard operating procedures, and work plans; semistructured key informant interviews were conducted with site coordinators to characterize staffing, site-level factors facilitating or impeding effective community engagement, study recruitment, and retention. Data from completed surveys and site standard operating procedures were collated, and notes from key informant interviews were thematically coded for content by 2 independent reviewers. Several key themes emerged from the data, including the importance of inclusion of members of the community being studied as staff, institutional hiring practices that support inclusive staffing, cultivating a supportive working environment for study implementation, and ongoing relationships between research institutions and community. This study underscores the importance of staffing in implementing research with black MSM. Investigators should consider how staffing and organizational structures affect implementation during study design and when preparing to initiate study activities. Ongoing monitoring of community engagement can inform and improve methods for engagement and ensure cultural relevance while removing barriers for participation.

Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional trauma systems.

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...

Functional Survey of Personnel Operations in Institutions of Higher Education.

ERIC Educational Resources Information Center

Oberle, Rodney L.

1985-01-01

Results of a national survey of the titles, reporting relationships, staffing levels, budget sizes, assigned responsibilities, and other information about college and university personnel management are reported and analyzed. (MSE)

Clients' satisfaction with HIV treatment services in Bamenda, Cameroon: a cross-sectional study.

PubMed

Wung, Buh Amos; Peter, Nde Fon; Atashili, Julius

2016-07-19

Clients have explicit desires or requests for services when visiting hospitals; inadequate discovery of their needs may result in dissatisfaction. Patient satisfaction influences retention in HIV care, adherence to HAART and serves as determinant to HIV suppression. This study's objectives were to quantify clients' satisfaction with HIV services in Bamenda and determine relationship between satisfaction and clients' socio-demographic/structural characteristics. A cross-sectional study was conducted on HIV-positive patients followed-up, on treatment and who consulted in the Bamenda Regional Hospital treatment centre between July and August 2014. Participants consent was sought and data collected on client's level of satisfaction to staff-patient-communication, staff attitudes, privacy and confidentiality and staffing and amenities situations in the hospital. Data was collected using a structured questionnaire interviewer-administered by investigator and trained health personnel. Collected data was analyzed using Epi Info version 3.5.4 and clients' satisfaction measured using frequencies and percentages. A total of 384 participants took part in this study and their median age was 37 years (IQR: 29-46). Two hundred and seventy-four (71.4 %) participants were females. Overall satisfaction with HIV services was 91.2 % and participants reported less satisfaction with overall staffing and amenities situation of the centre (3.6 %). In the multivariate analysis, only being female, employed and perceiving high number of nurses working at the treatment centre remained significant predictors of overall satisfaction with HIV services. A high proportion of participants expressed satisfaction with HIV services. However, some dissatisfaction is masked in this high satisfaction level. This dissatisfaction underscores need to improve staff attitudes, staff-patient-communication, employ more staff and build better patient facilities. Future studies need to focus on assessing long-term progression of satisfaction levels with services and determinants of satisfaction involving larger samples in many treatment centres.

Using fingerprint image quality to improve the identification performance of the U.S. Visitor and Immigrant Status Indicator Technology Program

PubMed Central

Wein, Lawrence M.; Baveja, Manas

2005-01-01

Motivated by the difficulty of biometric systems to correctly match fingerprints with poor image quality, we formulate and solve a game-theoretic formulation of the identification problem in two settings: U.S. visa applicants are checked against a list of visa holders to detect visa fraud, and visitors entering the U.S. are checked against a watchlist of criminals and suspected terrorists. For three types of biometric strategies, we solve the game in which the U.S. Government chooses the strategy's optimal parameter values to maximize the detection probability subject to a constraint on the mean biometric processing time per legal visitor, and then the terrorist chooses the image quality to minimize the detection probability. At current inspector staffing levels at ports of entry, our model predicts that a quality-dependent two-finger strategy achieves a detection probability of 0.733, compared to 0.526 under the quality-independent two-finger strategy that is currently implemented at the U.S. border. Increasing the staffing level of inspectors offers only minor increases in the detection probability for these two strategies. Using more than two fingers to match visitors with poor image quality allows a detection probability of 0.949 under current staffing levels, but may require major changes to the current U.S. biometric program. The detection probabilities during visa application are ≈11–22% smaller than at ports of entry for all three strategies, but the same qualitative conclusions hold. PMID:15894628

Using fingerprint image quality to improve the identification performance of the U.S. Visitor and Immigrant Status Indicator Technology Program.

PubMed

Wein, Lawrence M; Baveja, Manas

2005-05-24

Motivated by the difficulty of biometric systems to correctly match fingerprints with poor image quality, we formulate and solve a game-theoretic formulation of the identification problem in two settings: U.S. visa applicants are checked against a list of visa holders to detect visa fraud, and visitors entering the U.S. are checked against a watchlist of criminals and suspected terrorists. For three types of biometric strategies, we solve the game in which the U.S. Government chooses the strategy's optimal parameter values to maximize the detection probability subject to a constraint on the mean biometric processing time per legal visitor, and then the terrorist chooses the image quality to minimize the detection probability. At current inspector staffing levels at ports of entry, our model predicts that a quality-dependent two-finger strategy achieves a detection probability of 0.733, compared to 0.526 under the quality-independent two-finger strategy that is currently implemented at the U.S. border. Increasing the staffing level of inspectors offers only minor increases in the detection probability for these two strategies. Using more than two fingers to match visitors with poor image quality allows a detection probability of 0.949 under current staffing levels, but may require major changes to the current U.S. biometric program. The detection probabilities during visa application are approximately 11-22% smaller than at ports of entry for all three strategies, but the same qualitative conclusions hold.

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.

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.

Achieving workforce growth in UK nursing: policy options and implications.

PubMed

Buchan, James

2009-01-01

This paper examines how the National Health Service (NHS) in the UK achieved significant nursing workforce growth during the period between 2000 and 2006 and discusses the policy implications of the methods used to achieve this staffing growth. Data analysis, literature review and policy analysis. NHS nurse staffing growth was approximately 25% over the period 1997-2007, with most growth occurring in the years between 1999 and 2005. Whilst increases in intakes to home-based pre-registration education was a factor in achieving growth, the pace and level of growth which occurred was only possible by using active international recruitment, which was adopted as a deliberate national policy. The numbers of nurses and midwives entering the UK from other countries increased rapidly from 1999 onwards, to a peak in 2002, and then reduced markedly in the period from 2005 onwards. The policy of supporting international recruitment shifted rapidly in late 2005/2006 when financial difficulties hit the NHS and staffing growth was curtailed. Active international recruitment can contribute to health sector staffing growth, assuming the recruiting country has the resources to recruit and can tap into international markets, but it may not be effective in addressing all types of skills shortages. If it is not well linked to other components of workforce planning it may cause difficulties of over expansion, as well as raising broader issues of the ethics and impact.

Biochemical and structural characterisation of the second oxidative crosslinking step during the biosynthesis of the glycopeptide antibiotic A47934.

PubMed

Ulrich, Veronika; Brieke, Clara; Cryle, Max J

2016-01-01

The chemical complexity and biological activity of the glycopeptide antibiotics (GPAs) stems from their unique crosslinked structure, which is generated by the actions of cytochrome P450 (Oxy) enzymes that affect the crosslinking of aromatic side chains of amino acid residues contained within the GPA heptapeptide precursor. Given the crucial role peptide cyclisation plays in GPA activity, the characterisation of this process is of great importance in understanding the biosynthesis of these important antibiotics. Here, we report the cyclisation activity and crystal structure of StaF, the D- O -E ring forming Oxy enzyme from A47934 biosynthesis. Our results show that the specificity of StaF is reduced when compared to Oxy enzymes catalysing C- O -D ring formation and that this activity relies on interactions with the non-ribosomal peptide synthetase via the X-domain. Despite the interaction of StaF with the A47934 X-domain being weaker than for the preceding Oxy enzyme StaH, StaF retains higher levels of in vitro activity: we postulate that this is due to the ability of the StaF/X-domain complex to allow substrate reorganisation after initial complex formation has occurred. These results highlight the importance of testing different peptide/protein carrier constructs for in vitro GPA cyclisation assays and show that different Oxy homologues can display significantly different catalytic propensities despite their overall similarities.

The Course Development Plan: Macro-Level Decisions and Micro-Level Processes

ERIC Educational Resources Information Center

Franker, Karen; James, Dennis

2016-01-01

A key step in distance learning project management is the creation of a course development plan. The plan should account for decisions related to materials, curriculum, delivery methods, staffing, technology applications, resources, reporting lines, and project management--issues that may require administrator involvement and support, particularly…

National Environmental/Energy Workforce Assessment for Region VI.

ERIC Educational Resources Information Center

National Field Research Center Inc., Iowa City, IA.

This report represents a detailed summation of existing workforce levels, training programs, career potential, and staffing level projections through 1981 for EPA Region VI. This region serves the Gulf fringe states of Texas, Arkansas, New Mexico, Oklahoma, and Louisiana. The specific pollution programs considered include air, noise, pesticides,…

National Environmental/Energy Workforce Assessment for New Mexico.

ERIC Educational Resources Information Center

National Field Research Center Inc., Iowa City, IA.

This report presents existing workforce levels, training programs and career potentials and develops staffing level projections (1976-1982) based on available information for the State of New Mexico. The study concerns itself with the environmental pollution control areas of air, noise, potable water, pesticides, radiation, solid waste,…

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.

Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices

PubMed Central

Dellefield, Mary Ellen; Corazzini, Kirsten

2015-01-01

Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given. PMID:27417811

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

PubMed Central

McGregor, Margaret J.; Cohen, Marcy; McGrail, Kimberlyn; Broemeling, Anne Marie; Adler, Reva N.; Schulzer, Michael; Ronald, Lisa; Cvitkovich, Yuri; Beck, Mary

2005-01-01

Background Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care. Results The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18–0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15–0.30, p < 0.001) provided by support staff. Interpretation Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities. PMID:15738489

Nassriya Water Treatment Plant Nassriya, Iraq. Sustainment Assessment

DTIC Science & Technology

2008-04-28

Progress During Construction 8 Status of the WTP at Time of Turnover 11 Site Assessment 13 Continuing Problems for the Nassriya WTP 27...Future Plans for the Nassriya WTP 35 Conclusions 37 Recommendations 38 Management Comments 39 Evaluation of Management Comments 39...Appendices A. Scope and Methodology 40 B. FluorAmec’s Organizational Structure for the Nassriya WTP 41 C. FluorAmec’s Nassriya WTP Staffing Plan 42 D

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.

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.

Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study.

PubMed

Backhaus, Ramona; Rossum, Erik van; Verbeek, Hilde; Halfens, Ruud J G; Tan, Frans E S; Capezuti, Elizabeth; Hamers, Jan P H

2017-01-01

A lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes. To examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes. Cross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems. Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands. Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards. Ward rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward. Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards. In general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement 'In the event that a family member had to be admitted to a nursing home now, I would recommend this ward'. A better team climate was related to better perceived quality of care in both ward types (p≤0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p=0.028). In psychogeriatric wards, a lower score on market culture (p=0.019), better communication/coordination (p=0.018) and a higher rating for multidisciplinary collaboration (p=0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care. Our findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maintenance Trades Guidelines

ERIC Educational Resources Information Center

Weidner, Theodore J.

2008-01-01

In 2002, APPA published "Maintenance Staffing Guidelines for Educational Facilities," the first building maintenance trades staffing guideline designed to assist educational facilities professionals with their staffing needs. addresses how facilities professionals can determine the appropriate size and mix of their organization. Contents…

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 shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs.

South Texas Veterans Health Care System Mobile Health Clinic: Business Case Analysis

DTIC Science & Technology

2009-06-11

purchase a mobile health unit with no ancillary services with a clinical staffing of one physician’s assistant (PA) and one nurse practitioner (NP). A...total of four options were evaluated: (1) no ancillary with physician/registered nurse (RN) staffing, (2) no ancillary with PA/NP staffing, (3) radiology...one nurse practitioner (NP). A total of four options were evaluated: (1) no ancillary with physician/registered nurse (RN) staffing, (2) no

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

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.

Does mental health staffing level affect antipsychotic prescribing? Analysis of Italian national statistics.

PubMed

Starace, Fabrizio; Mungai, Francesco; Barbui, Corrado

2018-01-01

In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.

Accommodation of Nontraditional Aerospace Degree Aspirants

ERIC Educational Resources Information Center

Schukert, Michael A.

1977-01-01

Presents results of a national survey of institutions offering college level aerospace studies. Primary survey concern is the availability of nontraditional aerospace education programs; however, information pertaining to institution characteristics, program characteristics, and staffing are also included. (SL)

Campus-Level Decision-Making Practices: Principals and Teachers Differ in Their Views

ERIC Educational Resources Information Center

Noel, Cindi; Slate, John R.; Brown, Michelle; Tejeda-Delgado, Carmen

2009-01-01

With the implementation of site-based decision-making occurring in schools, the extent to which teachers perceive their involvement in decisions on planning, budgeting, curriculum, staffing patterns, staff development, and campus-level organization and the extent to which teachers' views of their involvement in these activities are congruent with…

Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover.

PubMed

Nelson-Brantley, Heather V; Park, Shin Hye; Bergquist-Beringer, Sandra

2018-01-01

The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.

Dominating Duffer’s Domain: Lessons for the U.S. Marine corps Information Operations Practitioner

DTIC Science & Technology

2017-01-01

an IO working group session, the public affairs officer pointed out that we had more latitude for broadcasts that were not MISO influence products ...this Duffer’s Drift–inspired text does for information operations ( IO ) what the original did for defensive tactics: effectively communicate timeless...fiction are Marines with current or future IO responsibilities and at least some understanding of Marine Expeditionary Unit (MEU) staffing processes

China’s Growing Military Power: Perpectives on Security, Ballistic Missiles, and Conventional Capabilities

DTIC Science & Technology

2002-09-01

Rice recently com pared th e present s y stem of agreem ents to th e geocentric concept of th e univ erse; th e future s y s tem of th e w orld to...neces sary . Norm ally , th e reserv e com m and post is staffed by th e w ar zone deputy logistics com m ander, oth er required staff officers

An inside look at NASA planetology

NASA Technical Reports Server (NTRS)

Dwornik, S. E.

1976-01-01

Staffing, financing and budget controls, and research grant allocations of NASA are reviewed with emphasis on NASA-supported research in planetary geological sciences: studies of the composition, structure, and history of solar system planets. Programs, techniques, and research grants for studies of Mars photographs acquired through Mariner 6-10 flights are discussed at length, and particularly the handling of computer-enhanced photographic data. Scheduled future NASA-sponsored planet exploration missions (to Mars, Jupiter, Saturn, Uranus) are mentioned.

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.

The Future Hospital: A Business Architecture View.

PubMed

Mokhtar, Ariffin Marzuki

2017-10-01

The future hospital is a resilient, physical learning facility featuring digital enhancement and leveraging an ecosystem of platforms for the Internet of Things (IoT) and analytics, achieving patient-centric care delivery via multidisciplinary healthcare provider teams coordinated to meet patients' medical, psychological, social and economic needs. It exists in a just ecosystem that assimilates the care spectrum from healthy living, the prevention of disease to acute care and the rehabilitation of patients recuperating from illnesses. It will take some time for these future hospitals to be built or for current hospitals to evolve and/or transform, but efforts to spread wisdom among the stakeholders, healthcare providers and patients must start now. The development of the digital components can also begin today, as can competency building for the healthcare providers who will be staffing these future hospitals, ensuring that they are equipped with competent staff employing patient-centric care processes that cater to patients' current and future needs.

The Future Hospital: A Business Architecture View

PubMed Central

Mokhtar, Ariffin Marzuki

2017-01-01

The future hospital is a resilient, physical learning facility featuring digital enhancement and leveraging an ecosystem of platforms for the Internet of Things (IoT) and analytics, achieving patient-centric care delivery via multidisciplinary healthcare provider teams coordinated to meet patients’ medical, psychological, social and economic needs. It exists in a just ecosystem that assimilates the care spectrum from healthy living, the prevention of disease to acute care and the rehabilitation of patients recuperating from illnesses. It will take some time for these future hospitals to be built or for current hospitals to evolve and/or transform, but efforts to spread wisdom among the stakeholders, healthcare providers and patients must start now. The development of the digital components can also begin today, as can competency building for the healthcare providers who will be staffing these future hospitals, ensuring that they are equipped with competent staff employing patient-centric care processes that cater to patients’ current and future needs. PMID:29386967

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 affected by interprofessional rounds or protocols for mechanical ventilation.

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.

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.

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 because it has workforce and industrial relations implications. Although there is significant literature available on the topic, there is a paucity of empirical evidence supporting claims of increased patient safety in the acute hospital setting, but some evidence exists relating to equity of workload for nurses. What does this paper add? This paper provides a contemporary qualitative analysis of empirical evidence using PRISMA methodology to conduct a systematic review of the available literature. It demonstrates a significant research gap to support claims of increased patient safety in the acute hospital setting. The paper calls for greatly improved datasets upon which research can be undertaken to determine any associations between mandated patient to nurse ratios and other staffing methodologies and patient safety and quality of care. What are the implications for practitioners? There is insufficient contemporary research to support staffing methodologies for appropriate staffing, balanced workloads and quality, safe care. Such research would include the establishment of nurse-sensitive patient outcomes measures, and more robust datasets are needed for empirical analysis to produce such evidence.

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%).

An exploratory analysis of treatment completion and client and organizational factors using hierarchical linear modeling.

PubMed

Woodward, Albert; Das, Abhik; Raskin, Ira E; Morgan-Lopez, Antonio A

2006-11-01

Data from the Alcohol and Drug Services Study (ADSS) are used to analyze the structure and operation of the substance abuse treatment industry in the United States. Published literature contains little systematic empirical analysis of the interaction between organizational characteristics and treatment outcomes. This paper addresses that deficit. It develops and tests a hierarchical linear model (HLM) to address questions about the empirical relationship between treatment inputs (industry costs, types and use of counseling and medical personnel, diagnosis mix, patient demographics, and the nature and level of services used in substance abuse treatment), and patient outcomes (retention and treatment completion rates). The paper adds to the literature by demonstrating a direct and statistically significant link between treatment completion and the organizational and staffing structure of the treatment setting. Related reimbursement issues, questions for future analysis, and limitations of the ADSS for this analysis are discussed.

Automation in the clinical microbiology laboratory.

PubMed

Novak, Susan M; Marlowe, Elizabeth M

2013-09-01

Imagine a clinical microbiology laboratory where a patient's specimens are placed on a conveyor belt and sent on an automation line for processing and plating. Technologists need only log onto a computer to visualize the images of a culture and send to a mass spectrometer for identification. Once a pathogen is identified, the system knows to send the colony for susceptibility testing. This is the future of the clinical microbiology laboratory. This article outlines the operational and staffing challenges facing clinical microbiology laboratories and the evolution of automation that is shaping the way laboratory medicine will be practiced in the future. Copyright © 2013 Elsevier Inc. All rights reserved.

Satellite Ground Operations Automation: Lessons Learned and Future Approaches

NASA Technical Reports Server (NTRS)

Catena, John; Frank, Lou; Saylor, Rick; Weikel, Craig; Obenschain, Arthur F. (Technical Monitor)

2001-01-01

Reducing spacecraft ground system operations costs is a major goal in all missions. The Fast Auroral Snapshot (FAST) flight operations team at the NASA/Goddard Spacecraft Flight Center developed in-house scripts and procedures to automate monitoring of critical spacecraft functions. The initial staffing profile of 16x7 was reduced first to 8x5 and then to 'lights out'. Operations functions became an offline review of system performance and the generation of future science plans for subsequent upload to the spacecraft. Lessons learned will be applied to the challenging Triana mission, where 24x7 contact with the spacecraft will be necessary at all times.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

PubMed

Cho, Eunhee; Lee, Nam-Ju; Kim, Eun-Young; Kim, Sinhye; Lee, Kyongeun; Park, Kwang-Ok; Sung, Young Hee

2016-08-01

The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. A cross-sectional survey. A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals. Copyright © 2016 Elsevier Ltd. All rights reserved.

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...

Orientation to Municipal Wastewater Treatment. Training Manual.

ERIC Educational Resources Information Center

Office of Water Program Operations (EPA), Cincinnati, OH. National Training and Operational Technology Center.

Introductory-level material on municipal wastewater treatment facilities and processes is presented. Course topics include sources and characteristics of municipal wastewaters; objectives of wastewater treatment; design, operation, and maintenance factors; performance testing; plant staffing; and laboratory considerations. Chapter topics include…

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...

Historical Trends

Cancer.gov

Since its establishment in 1937, the National Cancer Institute has served as a scientific cornerstone of the National Institutes of Health. Find information about the history of NCI appropriations and the Professional Judgment (Bypass) Budget, as well as data on funding trends and staffing levels.

Statistical and operational summaries

NASA Technical Reports Server (NTRS)

Disalvo, J.

1972-01-01

Statistical progress indicator forms are presented on the financial management of the research allocations. Promotional activities, conference participants, and services are tabulated. The staffing and activity levels are also discussed, as well as the fee schedule revision and the standard interest profile offerings.

Characterization of Current Tower Cab Environments

DOT National Transportation Integrated Search

1977-11-01

This report describes the general tower cab environment in terms of: (a) the evolution of the tower cab, current cab classification and staffing levels, and the basic flow of ATC data relevant to cab operations, (b) a breakdown of functions performed...

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...

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...

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…

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…

Seventy Years of RN Effectiveness: A Database Development Project to Inform Best Practice.

PubMed

Lulat, Zainab; Blain-McLeod, Julie; Grinspun, Doris; Penney, Tasha; Harripaul-Yhap, Anastasia; Rey, Michelle

2018-03-23

The appropriate nursing staff mix is imperative to the provision of quality care. Nurse staffing levels and staff mix vary from country to country, as well as between care settings. Understanding how staffing skill mix impacts patient, organizational, and financial outcomes is critical in order to allow policymakers and clinicians to make evidence-informed staffing decisions. This paper reports on the methodology for creation of an electronic database of studies exploring the effectiveness of Registered Nurses (RNs) on clinical and patient outcomes, organizational and nurse outcomes, and financial outcomes. Comprehensive literature searches were conducted in four electronic databases. Inclusion criteria for the database included studies published from 1946 to 2016, peer-reviewed international literature, and studies focused on RNs in all health-care disciplines, settings, and sectors. Masters-prepared nurse researchers conducted title and abstract screening and relevance review to determine eligibility of studies for the database. High-level analysis was conducted to determine key outcomes and the frequency at which they appeared within the database. Of the initial 90,352 records, a total of 626 abstracts were included within the database. Studies were organized into three groups corresponding to clinical and patient outcomes, organizational and nurse-related outcomes, and financial outcomes. Organizational and nurse-related outcomes represented the largest category in the database with 282 studies, followed by clinical and patient outcomes with 244 studies, and lastly financial outcomes, which included 124 studies. The comprehensive database of evidence for RN effectiveness is freely available at https://rnao.ca/bpg/initiatives/RNEffectiveness. The database will serve as a resource for the Registered Nurses' Association of Ontario, as well as a tool for researchers, clinicians, and policymakers for making evidence-informed staffing decisions. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Human resource staffing and service functions of community health services organizations in China.

PubMed

Yang, Jun; Guo, Aimin; Wang, Yadong; Zhao, Yali; Yang, Xinhua; Li, Hang; Duckitt, Roger; Liang, Wannian

2008-01-01

We report a study on the developmental status of human resource staffing and service functions of community health services (CHS) in China and offer recommendations for improving the CHS in the future. A study questionnaire was completed by 712 CHS organizations distributed in 52 cities and districts in all areas of China using a multilevel stratified randomized sampling method. Data were collected on the backgrounds, human resources, and service functions of CHS organizations. We found that 68.2% of doctors and 86.5% of nurses employed in CHS centers have low-level medical training. The doctor-nurse ratio in CHS centers is 1.2 to 1 and in CHS stations is 1.3 to 1. More than 50% of CHS organizations have developed on-the-job training programs, causing cost trends for staff training to increase. Although the delivery of basic clinical services and public health services is steadily increasing, 58.6% of stations are open less than 12 hours per day. Health records are established in a high proportion of CHS organizations. Two kinds of health education--general public health education, and personal education for specific problems--have been adopted by more than 92% of CHS centers and 90% of CHS stations. Desired functions for CHS organizations have been partially achieved. Training for doctors and nurses engaged in CHS should be promoted and improved as quickly as possible. Training in basic clinical services and management of noncommunicable chronic diseases should be strongly promoted. Changes in government policies should be pursued to promote effective support for the development of CHS.

Missed Nursing Care and Unit-Level Nurse Workload in the Acute and Post-Acute Settings.

PubMed

Orique, Sabrina B; Patty, Christopher M; Woods, Ellen

2016-01-01

This study replicates previous research on the nature and causes of missed nursing care and adds an explanatory variable: unit-level nurse workload (patient turnover percentage). The study was conducted in California, which legally mandates nurse staffing ratios. Findings demonstrated no significant relationship between patient turnover and missed nursing care.

77 FR 13351 - Polaris Industries, Including On-site Leased Workers From Westaff, Supply Technologies, Aerotek...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

..., Volt Workforce Solutions and Select Staffing, Osceola, WI; Amended Certification Regarding Eligibility... recreational vehicles. The company reports that workers leased from Select Staffing were employed on-site at... Select Staffing working on-site at the Osceola, Wisconsin location of Polaris Industries. The amended...

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.

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.

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.

29 CFR 1952.103 - Compliance staffing benchmarks.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... of 28 health compliance officers. Oregon elected to retain the safety benchmark level established in... State operating an approved State plan. In October 1992, Oregon completed, in conjunction with OSHA, a...

29 CFR 1952.103 - Compliance staffing benchmarks.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... of 28 health compliance officers. Oregon elected to retain the safety benchmark level established in... State operating an approved State plan. In October 1992, Oregon completed, in conjunction with OSHA, a...

Army Contracting Command Workforce Model Analysis

DTIC Science & Technology

2010-10-04

College), and he has taught visiting seminars at American University in Cairo, and Instituto de Empresas in Madrid. Dr. Reed retired after 21 years... Transportation –Federal Aviation Administration and will use historical program data to derive recommended staffing levels for major acquisition

Medical services at a music festival.

PubMed

Streat, S; McCallum, J A; Boswell, R; Hunton, R

1975-08-13

A three-day open air musical festival attended by approximately 20 000 people was held at Ngaruawahia in January 1973. A medical service was provided and staffed mainly by medical students, nurses and young medical graduates. There were 1998 patient visits to the medical area, the five most common complaints being sunburn, headaches, minor foot trauma, gastroenteritis and lacerations which collectively accounted for 75 percent of the diagnoses. The medical services provided are discussed and recommendations for future festivals made.

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

Insights: Future of the national laboratories. National Renewable Energy Laboratory. [The future of the National Renewable Energy (Sources) Laboratory

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

Sunderman, D.

Psychologists tell us that people are born with certain personality traits, such as shyness or boldness, which their environment can encourage, subdue, or even alter. National labs have somewhat similar characteristics. They were created for particular missions and staffed by people who built organizations in which those missions could be fulfilled. As a result, the Department of Energy's (DOE) national labs are among the world's finest repositories of technology and scientific talent, especially in the fields of defense, nuclear weapons, nuclear power, and basic energy. Sunderman, director of the National Renewable Energy Laboratory, discusses the history of the laboratory andmore » its place in the future, both in terms of technologies and nurturing.« less

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…

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…

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...

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...

78 FR 1252 - CalAmp Wireless Networks Corporation (CWNC), Satellite Products Division, Including On-Site...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-08

... Select Staffing, Oxnard, CA; CalAmp Wireless Networks Corporation (CWNC), Including On- Site Leased... Division, including on-site leased workers from Select Staffing, Oxnard, California (TA-W-80,399). The...-site leased workers from Select Staffing, Oxnard, California (TA-W-80,399) and CalAmp Wireless Networks...

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.

Patient ethnicity and three psychiatric intensive care units compared: the Tompkins Acute Ward Study.

PubMed

Bowers, L; Simpson, A; Nijman, H; Hall, C

2008-04-01

Psychiatric care units provide care to disturbed patients in a context of higher security and staffing levels. Although such units are numerous, few systematic comparisons have been made, and there are indications that ethnic minority groups may be over-represented. The aim of this study was to compare the rates of adverse incidents and patterns of usage of three psychiatric intensive care units. The study used a triangulation or multi-method design, bringing together data from official statistics, local audit and interviews conducted with staff. Intensive care patients were more likely to be young, male and suffering a psychotic disorder, as compared with general acute ward patients. Caribbean patients were twice as likely, and Asian patients half as likely, to receive intensive care (age, gender and diagnosis controlled). There were large differences in service levels, staffing, team functioning and adverse incidents between the three units. Various aspects of physical security were important in preventing absconds. More evaluative research is required in order to define effective service levels, and to explore the nature of the interaction between ethnicity and inpatient care provision during acute illness.

Let's Get Fit!: Fitness Activities for Children with Severe/Profound Disabilities.

ERIC Educational Resources Information Center

Modell, Scott J.; Cox, Thomas Alan

1999-01-01

Guidelines for developing a physical activity program for students with severe/profound disabilities address medical clearance; levels of participation; staffing; equipment; and program components, including warm-up, range of motion/flexibility activities, aerobics, resistance training, and cool-down. (DB)

29 CFR 1952.263 - 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 1992, Michigan completed, in conjunction with OSHA, a reassessment of the levels initially established in 1980 and proposed revised benchmarks of 56 safety and 45...

29 CFR 1952.263 - 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 1992, Michigan completed, in conjunction with OSHA, a reassessment of the levels initially established in 1980 and proposed revised benchmarks of 56 safety and 45...

Association between addiction treatment staff professional and educational levels and perceptions of organizational climate and resources.

PubMed

Krull, Ivy; Lundgren, Lena; Beltrame, Clelia

2014-01-01

Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.

Acute coronary syndrome on Friday the 13th: a case for re-organising services?

PubMed

Protty, Majd B; Jaafar, Mustafa; Hannoodee, Sahar; Freeman, Phillip

2016-12-12

Friday the 13th is described as an "unlucky" day that brings misfortune. There are few studies on the question, and none on its effect in cardiovascular patients. The recently misreported "weekend effect" has led to changes in the junior doctor contract in England, providing greater staffing levels on weekends. Should we make similar provisions for Friday the 13th? A retrospective analysis of a large database for patients admitted to hospitals in South Wales with an acute coronary syndrome (ACS) during 1999-2014. Mortality rates for 217 admission day number/name combinations and for Friday the 13th were compared in a Cox proportional hazards regression model. 56 062 ACS patients were identified. There were no significant differences in 13-year mortality between most admission dates (211 of 216) and Friday the 13th. However, a statistically significant reduction in mortality was identified for five dates: Thursday the 15th (HR, 0.77; 95% CI, 0.59-0.999), Wednesday the 18th (HR, 0.76; 95% CI, 0.58-0.99), Monday the 28th (HR, 0.76; 95% CI, 0.57-0.99), Monday the 30th (HR, 0.75; 95% CI, 0.57-0.99) and Tuesday the 31st (HR, 0.71; 95% CI, 0.51-0.99). On most days, there was no difference in the 13-year mortality rate for patients admitted with their first ACS from that for "unlucky" Friday the 13th. However, patients admitted on five day/number combinations were 20-30% more likely to survive at 13 years. These findings could be explained by subgroup analysis inflation of the type I error, although supernatural causes merit further investigation. Our findings should be taken into account in future junior doctor contract negotiations, and may provide a case for reduced staffing levels on these lucky days.

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.

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

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

PubMed Central

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

PubMed

Joyce, R; Webb, R; Peacock, J L

2004-01-01

Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with higher levels of consultant obstetric staffing. There were no apparent associations between neonatal death rates and the hospital factors measured here.

Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach.

PubMed

Cho, Hyeonmi; Han, Kihye

2018-05-14

This study aimed to determine the relationships among the unit-level nursing work environment and individual-level health-promoting behaviors of hospital nurses in South Korea and their perceived nursing performance quality. This study used a cross-sectional design. Data were collected using self-reported questionnaires from 432 nurses in 57 units at five hospitals in South Korea. Nursing performance quality, nursing work environment, and health-promoting behaviors were measured using the Six Dimension Scale of Nursing Performance, Practice Environment Scale of the Nursing Work Index, and Health Promoting Lifestyle Profile-II, respectively. Nurses working in units with nurse managers who were characterized by better ability and by quality leadership, and who provided more support to nurses exhibited significantly greater health responsibility and physical activity. Nurses working with sufficient staffing and resources reported better stress management. Positive collegial nurse-physician relationships in units were significantly associated with more healthy eating among nurses. Nurses working in units with sufficient staffing and resources, and who had a higher level of spiritual growth and health responsibility, were more likely to perceive their nursing performance quality as being higher. To improve the quality of nursing practice, hospitals should focus on helping nurses maintain healthy lifestyles, as well as improving their working conditions in South Korea. Organizational support for adequate human resources and materials, mutual cooperation among nurses and physicians, and workplace health-promotion interventions for spiritual growth and health responsibility are needed. Organizational efforts to provide sufficient staffing and resources, boost the development of personal resources among nurses, and promote nurses' responsibility for their own health could be effective strategies for improving nursing performance quality and patient outcomes. © 2018 Sigma Theta Tau International.

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

PubMed

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

Major advances in extension education programs in dairy production.

PubMed

Chase, L E; Ely, L O; Hutjens, M F

2006-04-01

The dairy industry has seen structural changes in the last 25 yr that have an impact on extension programming. The number of cows in the United States has decreased by 17%, whereas the number of dairy farms has decreased by 74%. The average milk production per cow has increased from 5,394 to 8,599 kg/lactation. Even though there are fewer farms, dairy farm managers are asking for more specific and targeted information. The extension resources available have also decreased during this period. Because of these changes, shifts have taken place in extension programming and staffing. A key change has been a shift to subject matter-targeted programs and workshops. Extension has also incorporated and expanded use of the Internet. Discussion groups, subject matter courses, and searchable databases are examples of Internet use. There will be continuing shifts in the demographics of the US dairy industry that will influence future extension efforts. It is also probable that fewer extension professionals will be available to provide programming due to changes in funding sources at national, state, and local levels. Future shifts in extension programming will be needed to provide the information needs of the industry with a smaller number of extension workers.

Military Nursing Outcomes Database (MilNOD IV): Analysis & Expansion

DTIC Science & Technology

2011-03-29

Nurse - Level Nurse job satisfaction, nursing staff education and experience, and the nursing work environment were assessed at...dissatisfies nurses . Our analysis did not show any effect of staffing on nurse job satisfaction. 4. Should the PES should be used for all skill levels ...and patient mortality, nurse burnout , and job dissatisfaction. Journal of the American Medical Association, 288,

The Relationship of Staffing Characteristics to Child Outcomes in Day Care.

ERIC Educational Resources Information Center

Oyemade, Ura Jean; Chargois, Michele

This paper presents evidence of the need to apply specific levels of competence to day care center staff, and describes the impact of these levels of competence on the children receiving care. Nine categories of staff necessary for quality day care are discussed and the duties of each are outlined. The categories are center director, director of…

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.

Nurses' practice environment and work-family conflict in relation to burn out: a multilevel modelling approach.

PubMed

Leineweber, Constanze; Westerlund, Hugo; Chungkham, Holendro Singh; Lindqvist, Rikard; Runesdotter, Sara; Tishelman, Carol

2014-01-01

To investigate associations between nurse work practice environment measured at department level and individual level work-family conflict on burnout, measured as emotional exhaustion, depersonalization and personal accomplishment among Swedish RNs. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analysed here is based on a national sample of 8,620 RNs from 369 departments in 53 hospitals. Generally, RNs reported high values of personal accomplishment and lower values of emotional exhaustion and depersonalization. High work-family conflict increased the risk for emotional exhaustion, but for neither depersonalization nor personal accomplishment. On department level adequate staffing and good leadership and support for nurses reduced the risk for emotional exhaustion and depersonalization. Personal accomplishment was statistically significantly related to staff adequacy. The findings suggest that adequate staffing, good leadership, and support for nurses are crucial for RNs' mental health. Our findings also highlight the importance of hospital managers developing policies and practices to facilitate the successful combination of work with private life for employees.

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…

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…

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,…

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…

Globalization and the Inward Flow of Immigrants: Issues Associated with the Inpatriation of Global Managers

ERIC Educational Resources Information Center

Harvey, Michael; Kiessling, Tim; Moeller, Miriam

2011-01-01

Assembling a diverse global workforce is becoming a critical dimension in gaining successful global performance. In the past, staffing has focused on control of the multinational organization as the primary goal when staffing overseas positions. As organizations globalize their operations, the goal of staffing is shifting from control to…

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…

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...

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...

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…

76 FR 13662 - Pass & Seymour/Legrand a Subsidiary of Legrand North America; Including On-Site Leased Workers...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

... Subsidiary of Legrand North America; Including On-Site Leased Workers From Select Staffing, also Known as... subsidiary of Legrand North America, including on-site leased workers from Select Staffing and Aerotek... reviewed the certification for workers of the subject firm. The company reports that Select Staffing, an on...

Preparing ICUs for pandemics.

PubMed

Gabriel, Lucinda E K; Webb, Steve A R

2013-10-01

Influenza pandemics occur intermittently and represent an existential global infectious diseases threat. The purpose of this review is to describe clinical and research preparedness for future pandemics. Pandemic influenza typically results in large numbers of individuals with life-threatening pneumonia requiring treatment in ICUs. Clinical preparedness of ICUs relates to planning to provide increased 'surge' capacity to meet increased demand and requires consideration of staffing, equipment and consumables, bed-space availability and management systems. Research preparedness is also necessary, as timely clinical research has the potential to change the trajectory of a pandemic. The clinical research response during the 2009 H1N1 influenza pandemic was suboptimal. Better planning is necessary to optimize both clinical and research responses to future pandemics.

Surviving the perfect storm: staff perceptions of mandatory overtime.

PubMed

Jacobsen, Catherine; Holson, Deborah; Farley, Jean; Charles, Jennell; Suel, Patricia

2002-09-01

Historically, mandatory overtime has been used to provide adequate staffing in times of crisis; however, as a result of today's severe nursing shortage, hospitals and other healthcare institutions are more commonly using mandatory overtime as a daily management tool to meet staffing requirements. This practice has created turmoil between management and staff in providing quality healthcare. Nursing literature describing staff nurses' views of overtime is limited. This article offers a description of the environment at the Hospital for Sick Children, a private nonprofit rehabilitation and transitional care pediatric hospital in Washington, DC, and the challenges the hospital faces in staffing the patient care units. This article also reports the results of the hospital's efforts to poll the nursing staff on their opinions regarding both voluntary and mandatory overtime and identifies conditions that influence the nursing staff's decisions and perceptions about overtime. Survey results will be used to modify existing staffing strategies and implement new staffing policies.

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

5 CFR 9901.516 - Internal placement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Internal placement. 9901.516 Section 9901... PERSONNEL SYSTEM (NSPS) Staffing and Employment External Recruitment and Internal Placement § 9901.516 Internal placement. (a) Determining levels of work and movement within and across career groups. The...

16 CFR 703.3 - Mechanism organization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Mechanism organization. 703.3 Section 703.3 Commercial Practices FEDERAL TRADE COMMISSION RULES, REGULATIONS, STATEMENTS AND INTERPRETATIONS UNDER THE... § 703.3 Mechanism organization. (a) The Mechanism shall be funded and competently staffed at a level...

40 CFR 57.603 - Criteria for approval.

Code of Federal Regulations, 2014 CFR

2014-07-01

... the proposed funding and staffing of the project appear adequate for its successful completion; (c) Whether the proposed level of funding for the project is consistent with the research and development... pollutants of both occupational and environmental significance; (f) The potential effects of the project on...

40 CFR 57.603 - Criteria for approval.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the proposed funding and staffing of the project appear adequate for its successful completion; (c) Whether the proposed level of funding for the project is consistent with the research and development... pollutants of both occupational and environmental significance; (f) The potential effects of the project on...

40 CFR 57.603 - Criteria for approval.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the proposed funding and staffing of the project appear adequate for its successful completion; (c) Whether the proposed level of funding for the project is consistent with the research and development... pollutants of both occupational and environmental significance; (f) The potential effects of the project on...

40 CFR 57.603 - Criteria for approval.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the proposed funding and staffing of the project appear adequate for its successful completion; (c) Whether the proposed level of funding for the project is consistent with the research and development... pollutants of both occupational and environmental significance; (f) The potential effects of the project on...

A Special Report on Middle Schools.

ERIC Educational Resources Information Center

Hollifield, John H.

1988-01-01

The first Center for Research on Elementary and Middle Schools (CREM) report describes the structures and practices currently used at all school levels for staffing, grouping, and scheduling. The report assesses the effects of departmentalization, tracking, ability grouping, and grade spans on student learning and development. (MLH)

History of Medical Specialty Interest Assessment

ERIC Educational Resources Information Center

Burns, Stephanie T.

2016-01-01

Medical specialties require decidedly different abilities, skills, and talents; which results in divergent experiences, lifestyles, skill sets, and income levels. To help medical students select their preferred medical specialty and alleviate shortages in medical specialty staffing, US medical schools and associations invest time and money in…

Institutional and economic influences on quality of nursing documentation.

PubMed

Parker, L E; Wells, K B; Buchanan, J L; Benjamin, B

1994-01-01

This study evaluates the quality of nursing documentation within the hospital record for a particularly vulnerable group of patients, the depressed aged. Specifically, the effects of prospective payment, unit type, hospital type, and nurse staffing levels on nursing documentation within hospital charts were assessed.

45 CFR 2552.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2014 CFR

2014-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... management policies and procedures covering project and Foster Grandparent activities. This includes...

45 CFR 2552.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2013 CFR

2013-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... management policies and procedures covering project and Foster Grandparent activities. This includes...

45 CFR 2552.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2012 CFR

2012-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... management policies and procedures covering project and Foster Grandparent activities. This includes...

45 CFR 2552.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2011 CFR

2011-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... management policies and procedures covering project and Foster Grandparent activities. This includes...

7 CFR 235.5 - Payments to States.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS STATE ADMINISTRATIVE EXPENSE FUNDS § 235.5 Payments to States. (a) Method of... shall include: (i) The staffing pattern for State level personnel; (ii) A budget for the forthcoming...

7 CFR 235.5 - Payments to States.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS STATE ADMINISTRATIVE EXPENSE FUNDS § 235.5 Payments to States. (a) Method of... shall include: (i) The staffing pattern for State level personnel; (ii) A budget for the forthcoming...

7 CFR 235.5 - Payments to States.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS STATE ADMINISTRATIVE EXPENSE FUNDS § 235.5 Payments to States. (a) Method of... shall include: (i) The staffing pattern for State level personnel; (ii) A budget for the forthcoming...

7 CFR 235.5 - Payments to States.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS STATE ADMINISTRATIVE EXPENSE FUNDS § 235.5 Payments to States. (a) Method of... shall include: (i) The staffing pattern for State level personnel; (ii) A budget for the forthcoming...

7 CFR 235.5 - Payments to States.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS STATE ADMINISTRATIVE EXPENSE FUNDS § 235.5 Payments to States. (a) Method of... shall include: (i) The staffing pattern for State level personnel; (ii) A budget for the forthcoming...

20 CFR 632.40 - Administrative staff and personnel standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Administrative staff and personnel standards....40 Administrative staff and personnel standards. (a) Staffing. Members of the population to be served... career advancement. (b) Compensation. Compensation for administrative staff shall be at levels consistent...

20 CFR 632.40 - Administrative staff and personnel standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Administrative staff and personnel standards....40 Administrative staff and personnel standards. (a) Staffing. Members of the population to be served... career advancement. (b) Compensation. Compensation for administrative staff shall be at levels consistent...

20 CFR 632.40 - Administrative staff and personnel standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Administrative staff and personnel standards....40 Administrative staff and personnel standards. (a) Staffing. Members of the population to be served... career advancement. (b) Compensation. Compensation for administrative staff shall be at levels consistent...

Organizational Characteristics Associated with Staff Turnover in Nursing Homes

ERIC Educational Resources Information Center

Castle, Nicholas G.; Engberg, John

2006-01-01

Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality,…

Improving the Cost Estimation of Space Systems. Past Lessons and Future Recommendations

DTIC Science & Technology

2008-01-01

a reasonable gauge for the relative propor- tions of cost growth attributable to errors, decisions, and other causes in any MDAP. Analysis of the...program. The program offices visited were the Defense Metrological Satellite Pro- gram (DMSP), Evolved Expendable Launch Vehicle (EELV), Advanced...3 years 1.8 0.9 3–8 years 1.8 0.9 8+ years 3.7 1.8 Staffing Requirement 7.4 3.7 areas represent earned value and budget drills ; the tan area on top

The Region 4 collaborative virtual reference project.

PubMed

Parker, Sandi K; Johnson, E Diane

2003-01-01

In May 2002, the Denison Memorial Library at the University of Colorado Health Sciences Center and the J. Otto Lottes Health Sciences Library at the University of Missouri-Columbia, with funding from the National Network of Libraries of Medicine-Midcontinental Region, embarked on a collaborative, real-time reference project using the 24/7 Reference, Inc., software package. This paper describes how the project was conceived, and includes details on the service hours, staffing, training, marketing, lessons learned, and future plans for the service.

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.…

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...

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.

Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule.

PubMed

2015-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.

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.

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.

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.

29 CFR 1952.103 - Compliance staffing benchmarks.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., DEPARTMENT OF LABOR (CONTINUED) APPROVED STATE PLANS FOR ENFORCEMENT OF STATE STANDARDS Oregon § 1952.103... State operating an approved State plan. In October 1992, Oregon completed, in conjunction with OSHA, a... of 28 health compliance officers. Oregon elected to retain the safety benchmark level established in...

29 CFR 1952.103 - Compliance staffing benchmarks.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF LABOR (CONTINUED) APPROVED STATE PLANS FOR ENFORCEMENT OF STATE STANDARDS Oregon § 1952.103... State operating an approved State plan. In October 1992, Oregon completed, in conjunction with OSHA, a... of 28 health compliance officers. Oregon elected to retain the safety benchmark level established in...

45 CFR 2552.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Assume full responsibility for securing maximum and continuing community financial and in-kind support to operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2011 CFR

2011-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2014 CFR

2014-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2012 CFR

2012-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

45 CFR 2553.25 - What are a sponsor's administrative responsibilities?

Code of Federal Regulations, 2013 CFR

2013-10-01

... operate the project successfully. (b) Provide levels of staffing and resources appropriate to accomplish the purposes of the project and carry out its project management responsibilities. (c) Employ a full... staff positions in the sponsor organization and/or project service area. (f) Establish risk management...

Software Acquisition Process (SWAP) Model FY81

DTIC Science & Technology

1982-12-01

experience. In addition, the manpower accounting techniques and the effects of resource limitation are described below. a. Contractor Personnel. Five job...developed are each oriented to a specific type of developmental activity. Between them, they account for all types of activities in the acquisition...manning levels and duration; Decision Box probability; and project staffing levels. They take into account the overall size of the project and the

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…

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.

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.

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.

Food Preservation Mini-Modules Offer Options for Learners and Extension Staff

ERIC Educational Resources Information Center

Driessen, Suzanne

2013-01-01

Renewed interest in growing and purchasing locally grown foods quadrupled requests for food preservation classes. Economic times tightened budgets, decreasing staffing levels of Extension educators. Offering options via the Internet was a natural progression to meet the increased demand. Extension educators created 20 5-minute online video--like…

Examining Elementary Social Studies Marginalization: A Multilevel Model

ERIC Educational Resources Information Center

Fitchett, Paul G.; Heafner, Tina L.; Lambert, Richard G.

2014-01-01

Utilizing data from the National Center for Education Statistics Schools and Staffing Survey (SASS), a multilevel model (Hierarchical Linear Model) was developed to examine the association of teacher/classroom and state level indicators on reported elementary social studies instructional time. Findings indicated that state testing policy was a…

Descent into the Maelstrom: Anthropology in the Politics of Academe.

ERIC Educational Resources Information Center

Salovesh, Michael

Conditions in academic employment associated with increasingly tense political struggles for anthropology departments are discussed. Personnel policies for state-supported institutions are cited as areas of major controversy and the effect of student enrollments on the setting of staffing-level parameters is emphasized. Politics internal to…

Library 2.0: Service for the Next-Generation Library

ERIC Educational Resources Information Center

Casey, Michael E.; Savastinuk, Laura C.

2006-01-01

Libraries are changing. Funding limits and customer demands are transforming staffing levels, service models, access to resources, and services to the public. Administrators and taxpayers are seeking more efficient ways of delivering services to achieve greater returns on financial investments. In this article, the author discusses the benefits of…

The Mathematics Teacher Development with Peer Tutoring Program.

ERIC Educational Resources Information Center

Duffie, William B.; Guida, Frank V.

This project addresses the problem of inadequate mathematics high school teacher staffing and the shortage of mathematics specialists in the elementary school. Regular elementary school teachers interested in becoming certified as high school mathematics teachers, and who had taken at least three college-level mathematics courses, were invited to…

School Safety Gets the Ax

ERIC Educational Resources Information Center

Eisele-Dyrli, Kurt

2010-01-01

A new informal federal survey has found that for many districts, budget cuts have had a profound effect on school safety and security measures. Administrators have been forced to cut safety and security staffing and programs, reorganize security departments and find alternative sources of funding in order to maintain levels of safety and security…

Rural Aspirations and Expectations of Ohio and Georgia Secondary Students.

ERIC Educational Resources Information Center

McCracken, J. David; And Others

Different areas and regions of the nation have characteristically different rural high school systems due to differences in socioeconomic status of the residents, racial or ethnic membership, and family background. Differences in staffing patterns, enrollment levels, and school budgets are also characteristics that help to differentiate rural and…

An Equilibrium Flow Model of a University Campus.

ERIC Educational Resources Information Center

Oliver, Robert M.; Hopkins, David S. P.

This paper develops a simple deterministic model that relates student admissions and enrollments to the final demand for educated students. It includes the effects of dropout rates and student-teacher ratios on student enrollments and faculty staffing levels. Certain technological requirements are assumed known and given. These, as well as the…

Looking within to Improve Office Organization

ERIC Educational Resources Information Center

Malinowski, Matthew J.

2009-01-01

When tough economic times set in, school business administrators heighten their normal zeal in finding ways to reduce costs and improve efficiency. The author's school district recently underwent a yearlong internal self-analysis to examine and determine the proper staffing levels for the administrative functions within the school district's…

Applying WHO's 'workforce indicators of staffing need' (WISN) method to calculate the health worker requirements for India's maternal and child health service guarantees in Orissa State.

PubMed

Hagopian, Amy; Mohanty, Manmath K; Das, Abhijit; House, Peter J

2012-01-01

In one district of Orissa state, we used the World Health Organization's Workforce Indicators of Staffing Need (WISN) method to calculate the number of health workers required to achieve the maternal and child health 'service guarantees' of India's National Rural Health Mission (NRHM). We measured the difference between this ideal number and current staffing levels. We collected census data, routine health information data and government reports to calculate demand for maternal and child health services. By conducting 54 interviews with physicians and midwives, and six focus groups, we were able to calculate the time required to perform necessary health care tasks. We also interviewed 10 new mothers to cross-check these estimates at a global level and get assessments of quality of care. For 18 service centres of Ganjam District, we found 357 health workers in our six cadre categories, to serve a population of 1.02 million. Total demand for the MCH services guaranteed under India's NRHM outpaced supply for every category of health worker but one. To properly serve the study population, the health workforce supply should be enhanced by 43 additional physicians, 15 nurses and 80 nurse midwives. Those numbers probably under-estimate the need, as they assume away geographic barriers. Our study established time standards in minutes for each MCH activity promised by the NRHM, which could be applied elsewhere in India by government planners and civil society advocates. Our calculations indicate significant numbers of new health workers are required to deliver the services promised by the NRHM.