Staffing Preschools: Background Information.

ERIC Educational Resources Information Center

Katz, Lilian G.; Weir, Mary K.

This report explores background variables related to preschool teaching, and emphasizes that statistics fluctuate in early childhood education. The increase for preprimary enrollment of 3- and 4-year-olds was 26 percent from 1966 to 1967. Accurate figures on preschool teaching personnel are not available, but a large proportion of Head Start…

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.

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

PubMed

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

2017-06-01

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

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

PubMed

Liljamo, Pia; Lavander, Päivi; Kejonen, Pirjo

2016-01-01

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

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.

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

ERIC Educational Resources Information Center

Kamis-Gould, Edna; And Others

1991-01-01

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

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

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…

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.

Factors influencing the use of registered nurse overtime in hospitals, 1995-2000.

PubMed

Berney, Barbara; Needleman, Jack; Kovner, Christine

2005-01-01

To assess nurse overtime in acute care general hospitals and the factors that influence overtime among various hospitals and in the same hospitals from year to year. Staffing data from 1995 to 2000 from 193 acute general hospitals in New York State were used to examine hospital characteristics (size, location, RN unionization, hospital ownership, and teaching status) to determine whether they were associated with nurse overtime. The average weekly overtime RNs worked was 4.5% of total hours, varying from almost none to 16.6%. At mean overtime levels, nurses were working less overtime than the mean for manufacturing workers, but, at the extreme, nurses were working more than 6 hours overtime per week. Significant differences were observed in the use of overtime by hospital ownership and by union status. Nurses in government hospitals worked less overtime than did those in nongovernment hospitals. Nurses in unionized hospitals worked slightly more overtime than did nurses in nonunionized hospitals. Hospitals varied dramatically in their overtime use. That some categories of hospitals (e.g., government-owned) used little overtime indicates that hospital management can find substitutes for overtime to meet fluctuating staffing needs. The finding that hospitals with similar characteristics varied greatly in their number of overtime hours also supported this conclusion.

Toward zero waste: composting and recycling for sustainable venue based events.

PubMed

Hottle, Troy A; Bilec, Melissa M; Brown, Nicholas R; Landis, Amy E

2015-04-01

This study evaluated seven different waste management strategies for venue-based events and characterized the impacts of event waste management via waste audits and the Waste Reduction Model (WARM). The seven waste management scenarios included traditional waste handling methods (e.g. recycle and landfill) and management of the waste stream via composting, including purchasing where only compostable food service items were used during the events. Waste audits were conducted at four Arizona State University (ASU) baseball games, including a three game series. The findings demonstrate a tradeoff among CO2 equivalent emissions, energy use, and landfill diversion rates. Of the seven waste management scenarios assessed, the recycling scenarios provide the greatest reductions in CO2 eq. emissions and energy use because of the retention of high value materials but are compounded by the difficulty in managing a two or three bin collection system. The compost only scenario achieves complete landfill diversion but does not perform as well with respect to CO2 eq. emissions or energy. The three game series was used to test the impact of staffed bins on contamination rates; the first game served as a baseline, the second game employed staffed bins, and the third game had non staffed bins to determine the effect of staffing on contamination rates. Contamination rates in both the recycling and compost bins were tracked throughout the series. Contamination rates were reduced from 34% in the first game to 11% on the second night (with the staffed bins) and 23% contamination rates at the third game. Copyright © 2015 Elsevier Ltd. 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.

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

PubMed Central

Newton, J; Hunt, J; Stirling, J

1996-01-01

BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters of practice managers reported having received some type of formal training in staff management. CONCLUSION: This study shows that practice size is a major factor associated with differences in the organization and management of staffing. Any initiatives which increase the scale of primary care functions and services would have to address the issues of communication and coordination that might be associated with such a change. PMID:8855013

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.

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.

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.

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.

12 CFR 563b.105 - What information must I include in my business plan?

Code of Federal Regulations, 2011 CFR

2011-01-01

... expectations, and industry norms, by the final year of the business plan. You must include three years of... proceeds, and the effect of this plan on management resources, staffing, and facilities. (4) The expertise of your management and board of directors, or that you have planned for adequate staffing and...

Expanding the Parameters for Excellence in Patient Assignments: Is Leveraging an Evidence-Data-Based Acuity Methodology Realistic?

PubMed

Gray, Joel; Kerfoot, Karlene

2016-01-01

Finding the balance of equitable assignments continues to be a challenge for health care organizations seeking to leverage evidence-based leadership practices. Ratios and subjective acuity strategies for nurse-patient staffing continue to be the dominant approach in health care organizations. In addition to ratio-based assignments and acuity-based assignment models driven by financial targets, more emphasis on using evidence-based leadership strategies to manage and create science for effective staffing is needed. In particular, nurse leaders are challenged to increase the sophistication of management of patient turnover (admissions, discharges, and transfers) and integrate tools from Lean methodologies and quality management strategies to determine the effectiveness of nurse-patient staffing.

An observational study of the relationship between Capacity for Care as an animal shelter management model and cat health, adoption and death in three animal shelters.

PubMed

Karsten, C L; Wagner, D C; Kass, P H; Hurley, K F

2017-09-01

Animal shelters struggle to function at their 'right size' in terms of physical, staffing and outcome capacity, especially with seasonal fluctuations in cat intake. To address this, a Capacity for Care (C4C) management model was devised to balance health and welfare requirements of all animals while maintaining or improving goals for positive outcomes, such as adoption or transfer. In this observational study of three shelters, applying the C4C management system gave each organization an optimal average daily shelter cat population target (to be achieved through proactive length of stay management) and helped each shelter to increase the size of their feline housing units. Pre- and post-C4C implementation data were evaluated to determine impact on average monthly isolation ward populations and cat outcomes such as adoptions and shelter deaths (euthanasia/died). Improved outcomes including increased adoption probability, decreased shelter death probability and fewer cats requiring infectious disease isolation were seen after C4C institution. Results suggest that implementation of this management model could help other shelters achieve similar results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Optimizing the use of nursing pool resources.

PubMed

Kutash, M B; Nelson, D

1993-01-01

The use of per diem staff is a popular method of meeting staffing deficiencies related to fluctuations in volume and intensity of nursing service. The authors describe the reorganization of a nursing pool. This restructuring resulted in an increase of available pool hours, a decrease in overtime and agency use, and significant savings related to orientation costs.

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.

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.

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 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.

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

PubMed

Yu, Soyoung; Kim, Tae Gon

2015-05-01

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

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

PubMed

Krogh, Paul; Ernster, Jason; Knoer, Scott

2012-09-15

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

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.

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

PubMed

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

2016-01-01

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

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.

Toward zero waste: Composting and recycling for sustainable venue based events

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

Hottle, Troy A., E-mail: troy.hottle@asu.edu; Bilec, Melissa M., E-mail: mbilec@pitt.edu; Brown, Nicholas R., E-mail: nick.brown@asu.edu

Highlights: • Venues have billions of customers per year contributing to waste generation. • Waste audits of four university baseball games were conducted to assess venue waste. • Seven scenarios including composting were modeled using EPA’s WARM. • Findings demonstrate tradeoffs between emissions, energy, and landfill avoidance. • Sustainability of handling depends on efficacy of collection and treatment impacts. - Abstract: This study evaluated seven different waste management strategies for venue-based events and characterized the impacts of event waste management via waste audits and the Waste Reduction Model (WARM). The seven waste management scenarios included traditional waste handling methods (e.g.more » recycle and landfill) and management of the waste stream via composting, including purchasing where only compostable food service items were used during the events. Waste audits were conducted at four Arizona State University (ASU) baseball games, including a three game series. The findings demonstrate a tradeoff among CO{sub 2} equivalent emissions, energy use, and landfill diversion rates. Of the seven waste management scenarios assessed, the recycling scenarios provide the greatest reductions in CO{sub 2} eq. emissions and energy use because of the retention of high value materials but are compounded by the difficulty in managing a two or three bin collection system. The compost only scenario achieves complete landfill diversion but does not perform as well with respect to CO{sub 2} eq. emissions or energy. The three game series was used to test the impact of staffed bins on contamination rates; the first game served as a baseline, the second game employed staffed bins, and the third game had non staffed bins to determine the effect of staffing on contamination rates. Contamination rates in both the recycling and compost bins were tracked throughout the series. Contamination rates were reduced from 34% in the first game to 11% on the second night (with the staffed bins) and 23% contamination rates at the third game.« less

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

PubMed

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

2008-01-01

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

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.

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

PubMed

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

2006-10-01

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

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.

Staffing the Global Organization: "Cultural Nomads"

ERIC Educational Resources Information Center

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

2012-01-01

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

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%.

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

ERIC Educational Resources Information Center

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

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

Team Approach to Staffing the Reference Center: A Speculation.

ERIC Educational Resources Information Center

Lawson, Mollie D.; And Others

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

The Use of Flexible Staffing Arrangements in Core Production Jobs.

ERIC Educational Resources Information Center

Gramm, Cynthia L.; Schnell, John F.

2001-01-01

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

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

ERIC Educational Resources Information Center

Barratt, Will

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

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

ERIC Educational Resources Information Center

Glazner, Steve, Ed.

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

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

PubMed

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

2012-01-01

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

Applying science and strategy to operating room workforce management.

PubMed

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

2012-01-01

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

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

PubMed Central

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

2015-01-01

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

Critical care nurses' perceptions of the outcomes of working overtime in Canada.

PubMed

Lobo, Vanessa M; Ploeg, Jenny; Fisher, Anita; Peachey, Gladys; Akhtar-Danesh, Noori

Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict. The goal of this study was to explore critical care nurses' perceptions of the outcomes of working overtime. Sally Thorne's interpretive description guided the collection and analysis of data. Participants were recruited from 11 different critical care units within three large teaching hospitals in Southern Ontario, Canada. A total of 28 full- and part-time registered nurses who had worked in an intensive care unit for at least one year took part in this study. Data were collected through semistructured, audio-recorded, individual interviews that took place in rooms adjacent to participants' critical care units. Template analysis facilitated the determination and abstraction of themes using NVivo for Mac 10.1.1. Major themes highlighting the perceived outcomes of overtime included (a) physical effects, (b) impact on patient-centered care, (c) balancing family and work, (d) financial gain, and € safety is jeopardized. Nursing managers and institutions need to be accountable for staffing practices they institute, and nurses themselves may require further education regarding healthy work-life balance. There are both negative and positive consequences of nursing overtime for nurses and patients, but nurses at large valued the option to work it. Copyright © 2017 Elsevier Inc. All rights reserved.

An information system to improve financial management, resource allocation and activity planning: evaluation results.

PubMed

Ruland, C M; Ravn, I H

2001-01-01

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

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

PubMed

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

2016-01-01

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

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

PubMed

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

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

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.

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.

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

ERIC Educational Resources Information Center

Farquhar, Robin H.

2005-01-01

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

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…

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.

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.

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

PubMed

Ge, Yujia; Xu, Bin

2016-01-01

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

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

PubMed Central

Ge, Yujia; Xu, Bin

2016-01-01

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

77 FR 67653 - Statement of Organization, Functions, and Delegations of Authority; Office of the Deputy...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-13

..., including position management, performance management, employee recognition, staffing, recruitment, employee... management activities, including recruitment, selection, position management, performance management, designated performance and incentive awards and employee assistance programs and other services to ACF...

The impact of health information technology on staffing.

PubMed

Goldsack, Jennifer C; Robinson, Edmondo J

2014-02-01

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

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.

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.

Alternative arrangements for the delivery of eye care services within staff model managed care organizations.

PubMed

Soroka, Mort; Reis, Lesley; Krumholz, David; Krasner, Mel; Portello, Joan

2003-11-01

Eye care services, though accounting for only a small fraction of healthcare costs, encompass a unique spectrum of professional staffing options that can enhance efficiency and decrease costs within staff model managed care organizations. This study was designed to describe and assess alternative staffing arrangements and cost implications for the delivery of eye care services by optometrists, ophthalmologists, and primary care physicians within staff model managed care organizations. The clinical records of individual patients--rather than administrative and billing files--at three managed care organizations are the principal source of information. Clinical auditors extracted data on ambulatory eye care services provided for conjunctivitis, corneal abrasion/erosion, cataract, diabetic retinopathy, glaucoma, and macular degeneration. Our findings document the substantial role optometrists play in the delivery of eye care, whether they provide the care independently or in collaboration with an ophthalmologist. The levels of remuneration for optometrists are roughly one third to one half the annual rate for ophthalmologists. Staffing arrangements that use optometrists to the full extent of their professional training can provide significant cost savings. The cost-effectiveness of using the services of optometrists capable of delivering high-quality eye care can be demonstrated. Potential cost savings for staff model managed care organizations may accrue if the roles, functions, and availability of eye providers are adjusted.

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.

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.

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

PubMed

Puckett, F

1991-11-01

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

Consultant management estimating tool.

DOT National Transportation Integrated Search

2012-04-01

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

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.

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.

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.

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)

Teaching Principles of Management through Experiential and Service Learning

ERIC Educational Resources Information Center

Furutan, Omid

2014-01-01

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

Rationing nurses: Realities, practicalities, and nursing leadership theories.

PubMed

Fast, Olive; Rankin, Janet

2018-04-01

In this paper, we examine the practicalities of nurse managers' work. We expose how managers' commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We learned how nurse managers' responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers' responsibilities are shaped to conform to institutional purposes. © 2017 John Wiley & Sons Ltd.

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination.

PubMed

Swift, Melanie D; Aliyu, Muktar H; Byrne, Daniel W; Qian, Keqin; McGown, Paula; Kinman, Patricia O; Hanson, Katherine Louise; Culpepper, Demoyne; Cooley, Tamara J; Yarbrough, Mary I

2017-09-01

To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011-2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the "Flulapalooza method" as a best practice model to enhance efficiency.

Factors influencing new graduate nurse burnout development, job satisfaction and patient care quality: a time-lagged study.

PubMed

Boamah, Sheila A; Read, Emily A; Spence Laschinger, Heather K

2017-05-01

To test a hypothesized model linking new graduate nurses' perceptions of their manager's authentic leadership behaviours to structural empowerment, short-staffing and work-life interference and subsequent burnout, job satisfaction and patient care quality. Authentic leadership and structural empowerment have been shown to reduce early career burnout among nurses. Short-staffing and work-life interference are also linked to burnout and may help explain the impact of positive, empowering leadership on burnout, which in turn influences job satisfaction and patient care quality. A time-lagged study of Canadian new graduate nurses was conducted. At Time 1, surveys were sent to 3,743 nurses (November 2012-March 2013) and 1,020 were returned (27·3% response rate). At Time 2 (May-July 2014), 406 nurses who responded at Time 1 completed surveys (39·8% response rate). Descriptive analysis was conducted in SPSS. Structural equation modelling in Mplus was used to test the hypothesized model. The hypothesized model was supported. Authentic leadership had a significant positive effect on structural empowerment, which in turn decreased both short-staffing and work-life interference. Short-staffing and work-life imbalance subsequently resulted in nurse burnout, lower job satisfaction and lower patient care quality 1 year later. The findings suggest that short-staffing and work-life interference are important factors influencing new graduate nurse burnout. Developing nurse managers' authentic leadership behaviours and working with them to create and sustain empowering work environments may help reduce burnout, increase nurse job satisfaction and improve patient care quality. © 2016 John Wiley & Sons Ltd.

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…

What Is Effective School Management.

ERIC Educational Resources Information Center

De Cicco, James M.

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

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

PubMed

McDiarmid, Mary; Auster, Ethel

2005-04-01

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

Using volunteers in Ontario hospital libraries: views of library managers*

PubMed Central

McDiarmid, Mary; Auster, Ethel

2005-01-01

Background: Volunteers have been a resource for all types of libraries for many years. Little research has been done to describe the attitudes librarians have toward library volunteers. More specifically, the attitudes of hospital librarians toward volunteers have never been studied. Objective: The objective was to explore and describe the extent of volunteer use and to determine library managers' attitudes toward volunteers. Design, Setting, and Participants: An anonymous, self-report 38-item questionnaire was mailed to the target population of 89 hospital library managers in Ontario. Seventy-nine useable questionnaires were analyzed from an adjusted sample of 86 eligible respondents, resulting in a response rate of 92%. SPSS 11.5 was used to analyze the data. Findings: The data revealed the attitudes of managers using volunteers did not differ significantly from the attitudes of managers not using volunteers. The findings showed that a majority of managers did not believe their libraries were adequately staffed with paid employees. Sufficient evidence was found of an association between a manager's belief in the adequacy of staffing in the library and the use of volunteers in the library (χ2(1, N = 76) = 4.11, P = 0.043). Specifically, volunteers were more likely to be used by managers who did not believe their libraries were adequately staffed. The presence of a union in the library and the use of volunteers were also associated (χ2(1, N = 77) = 4.77, P = 0.029). When unions were present in the library, volunteers were less likely to be used. Implications: This research has implications for hospital library managers in the management of volunteers. Volunteers should not be viewed as a quick fix or as a long-term solution for a library's understaffing problem. PMID:15858629

The Ambulatory Care Workload Management System for Nursing Reference Manual

DTIC Science & Technology

1991-05-31

MEDICAL DATA SERVICES CENTER BETHESDA, MARYLAND 2088Q-506. 91-03029 SECuRItY CLASSIFICATION OF THIS PAGEr REPORT DOCUMENTATION PAGE Ia. REPORT SECURITY...ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION Naval Medical Data Servics (If applicable) Center 6c. ADDRESS (City, State, and ZIPCode) 7b...staffing methodology developed for emergency and ambulatory care departments in naval medical treatment facilities . The staffing model translates varying

A History of the Development of the Navy Medical Department’s Workload Management System for Nursing.

DTIC Science & Technology

1987-08-01

efficient and rational methodology. Young, Giovannetti, Lewison , and Thomas (1981) offer the following comprehensive definition of a staffing methodology... Johns Hopkins Hospital. Connor used industrial engineering techniques, such as work sampling, time and motion studies, and continuous observation, to time...ADA 109883-ADA 109886). Young, J.P., Giovannetti, P., Lewison , D., & Thomas, M.L. Factors Affecting Nurse Staffing in Acute Care Hospitals: A Review

32 CFR 651.6 - NEPA analysis staffing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY... management is not in the proponents' chain of command (for example, installation management of a range for MATDEV testing or installation management of a fielding location), the proponent shall coordinate the...

[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.

Personnel Management. Universities.

ERIC Educational Resources Information Center

Ohio Board of Regents, Columbus. Management Improvement Program.

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

5 CFR 370.102 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS INFORMATION TECHNOLOGY EXCHANGE... performance-related criteria established by the agency. Information technology (IT) management means the planning, organizing, staffing, directing, integrating, or controlling of information technology as defined...

5 CFR 370.102 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS INFORMATION TECHNOLOGY EXCHANGE... performance-related criteria established by the agency. Information technology (IT) management means the planning, organizing, staffing, directing, integrating, or controlling of information technology as defined...

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.

Developing an appropriate staff mix for anticoagulation clinics: functional job analysis approach

NASA Astrophysics Data System (ADS)

Hailemariam, Desta A.; Shan, Xiaojun; Chung, Sung H.; Khasawneh, Mohammad T.; Lukesh, William; Park, Angela; Rose, Adam

2018-05-01

Anticoagulation clinics (ACCs) are specialty clinics that manage patients with blood clotting problems. Since labor costs usually account for a substantial portion of a healthcare organization's budget, optimizing the number and types of staff required was often the focus, especially for ACCs, where labor-intensive staff-patient interactions occur. A significant portion of tasks performed by clinical pharmacists might be completed by clinical pharmacist technicians, which are less-expensive resources. While nurse staffing models for a hospital inpatient unit are well established, these models are not readily applicable to staffing ACCs. Therefore, the objective of this paper is to develop a framework for determining the right staff mix of clinical pharmacists and clinical pharmacy technicians that increases the efficiency of care delivery process and improves the productivity of ACC staff. A framework is developed and applied to build a semi-automated full-time equivalent (FTE) calculator and compare various staffing scenarios using a simulation model. The FTE calculator provides the right staff mix for a given staff utilization target. Data collected from the ACCs at VA Boston Healthcare System is used to illustrate the FTE calculator and the simulation model. The result of the simulation model can be used by ACC managers to easily determine the number of FTEs of clinical pharmacists and clinical pharmacy technicians required to reach the target utilization and the corresponding staffing cost.

5 CFR 9901.504 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Staffing and Employment General § 9901.504 Definitions. In this subpart— Career conditional...

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.

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/

The financial impact of a clinical academic practice partnership.

PubMed

Greene, Mary Ann; Turner, James

2014-01-01

New strategies to provide clinical experiences for nursing students have caused nursing schools and hospitals to evaluate program costs. A Microsoft Excel model, which captures costs and associated benefits, was developed and is described here. The financial analysis shows that the Clinical Academic Practice Program framework for nursing clinical education, often preferred by students, can offer financial advantages to participating hospitals and schools of nursing. The model is potentially a tool for schools of nursing to enlist hospitals and to help manage expenses of clinical education. Hospitals may also use the Hospital Nursing Unit Staffing and Expense Worksheet in planning staffing when students are assigned to units and the cost/benefit findings to enlist management support.

An Examination of Current Navy Medical Professionals Management Oriented Service Short Courses

DTIC Science & Technology

1993-06-17

diversity in the workplace .83 52. Building a climate that promotes ethical...staffing needs 50. Managing labor relations(union negotiations, grievances, etc.) 51. Managing multi-cultural diversity in the workplace 1.33 52. Building...needs 1.25 50. Managing labor relationsfunion negotiations, grievances. etc.) 51. Managing multi-cultural diversity in the workplace 52. Building

Organizing and Managing Small Rural Colleges: More Bang for the Buck.

ERIC Educational Resources Information Center

McCarter, W. Ronald; Barnes, Edwin L.

While small rural colleges have much the same goals as larger institutions, they have fewer resources with which to work, and therefore their management problems are unique. In the areas of staffing, time management, staff development, and recruitment and promotion, the small college can increase management effectiveness. Despite increasing…

The Encouragement and Development of Women into Education Management.

ERIC Educational Resources Information Center

Gold, Anne

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

Managers Handbook for Software Development

NASA Technical Reports Server (NTRS)

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

1984-01-01

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

Introduction to Personnel Management: Participants' Manual.

ERIC Educational Resources Information Center

Civil Service Commission, Denver, CO. Regional Training Center.

This manual for the introductory Federal personnel management course covers: major personnel laws and sources of information; position classification (standards and task analysis); staffing and placement (competitive appointments, temporary appointments/promotions, recruitment, and noncompetitive actions); merit promotion; qualification standards;…

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...

25 CFR 32.4 - Policies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... control in planning, priority-setting, development, management, operation, staffing and evaluation in all... exemplary programs reflecting Tribal or Alaska Native village specific learning styles, including but not... management information system which will provide statistical information such as, but not limited to, student...

Emergency Preparedness in the Workplace: The Flulapalooza Model for Mass Vaccination

PubMed Central

Aliyu, Muktar H.; Byrne, Daniel W.; Qian, Keqin; McGown, Paula; Kinman, Patricia O.; Hanson, Katherine Louise; Culpepper, Demoyne; Cooley, Tamara J.; Yarbrough, Mary I.

2017-01-01

Objectives. To explore whether an emergency preparedness structure is a feasible, efficient, and sustainable way for health care organizations to manage mass vaccination events. Methods. We used the Hospital Incident Command System to conduct a 1-day annual mass influenza vaccination event at Vanderbilt University Medical Center over 5 successive years (2011–2015). Using continuous quality improvement principles, we assessed whether changes in layout, supply management, staffing, and documentation systems improved efficiency. Results. A total of 66 591 influenza vaccines were administered at 5 annual Flulapalooza events; 13 318 vaccines per event on average. Changes to the physical layout, staffing mix, and documentation processes improved vaccination efficiency 74%, from approximately 38 to 67 vaccines per hour per vaccinator, while reducing overall staffing needs by 38%. An unexpected finding was the role of social media in facilitating active engagement. Conclusions. Health care organizations can use a closed point-of-dispensing model and Hospital Incident Command System to conduct mass vaccination events, and can adopt the “Flulapalooza method” as a best practice model to enhance efficiency. PMID:28892449

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.

PubMed

Anzai, Eriko; Douglas, Clint; Bonner, Ann

2014-06-01

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. © 2013 Wiley Publishing Asia Pty Ltd.

Relationship between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality among Rural U.S. Hospitals.

PubMed

Kozhimannil, Katy B; Hung, Peiyin; Casey, Michelle M; Henning-Smith, Carrie; Prasad, Shailendra; Moscovice, Ira S

2016-01-01

Many hospitals are adopting quality improvement strategies in obstetrics. This study characterized rural U.S. hospitals based on their hospital staffing and clinical management policies for labor induction and cesarean delivery, and assessed the relationship between policies and performance on maternity care quality. We surveyed all 306 rural maternity hospitals in nine states and used data from the Healthcare Cost and Utilization Project Statewide Inpatient Database hospital discharge database. We found staffing policies were more prevalent at lower-volume hospitals (92% vs. 86% for cesarean and 82% vs. 79%, both p < .01). Using multivariable logistic regression, we found hospitals with policies for cesarean delivery had up to 24% lower odds of low-risk cesarean (adjusted odds ratio = 0.76; 95% confidence interval=[0.67-0.86]) and non-indicated cesarean (0.78 [0.70-0.88]), with variability across birth volume. Clinical management and staffing policies are common, but not universal, among rural U.S. hospitals providing obstetric services and are generally positively associated with quality.

Assessment of Pharmacy Manpower and Services in New England.

PubMed

Robinson, Evan; Shcherbakova, Natalia; Backer, Louise

2016-12-01

This study assessed longitudinal trends in pharmacy staffing and services in the 6 New England states by comparing survey results from 2008 and 2013. A validated 32-item survey was mailed in 2008 and 2013 to a random sample of 2000 pharmacists. Each sample represented approximately 15% (2008) and 13% (2013) of the active rosters. Response rates were 24% in 2008 and 23% in 2013. In all, 45% of 2013 respondents reported a pharmacist position vacancy in the past 12 months versus 62% in 2008. In all, 12% of 2013 respondents agreed or strongly agreed with a statement regarding pharmacists' shortage versus 77% in 2008. Disease management services were reported to be offered by 23% of 2013 respondents versus 28% in 2008. Reasons for not offering the services in 2013 included the lack of staffing (61%), expertise (28%), and reimbursement (29%). In 2008, these results were 74%, 33%, and 31%, respectively. The pharmacist shortage within New England was alleviated during 2008 to 2013. Participation of pharmacists in disease management services did not follow staffing trends as fewer pharmacists reported providing services. Key barriers to services provision persist and consideration of how to resolve them (medication therapy management reimbursement and additional education) should be explored. © The Author(s) 2015.

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

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

PubMed

Fram, Nancy; Morgan, Beverley

2012-03-01

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

Qualitative and Quantitative Management Tools Used by Financial Officers in Public Research Universities

ERIC Educational Resources Information Center

Trexler, Grant Lewis

2012-01-01

This dissertation set out to identify effective qualitative and quantitative management tools used by financial officers (CFOs) in carrying out their management functions of planning, decision making, organizing, staffing, communicating, motivating, leading and controlling at a public research university. In addition, impediments to the use of…

77 FR 31643 - Siltronic Corporation FAB1 Plant Including On-Site Leased Workers From Express Temporaries...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... Secure Solutions USA, SBM Management Services, LP, ALSCO Portland Industrial, VWR International, Inc... G4S Secure Solutions USA, SBM Management Services, LP, Alsco Portland Industrial, VWR International... workers from Express Temporaries, Aerotek Commercial Staffing, G4S Secure Solutions USA, SBM Management...

The Tortoise and the Hare: Less Jogging, More Sprints and Marathons.

ERIC Educational Resources Information Center

Ginsburg, Sigmund G.

1992-01-01

To cope with changing financial and demographic environments, colleges are encouraged to change management strategies. Suggestions are made for policy formation and improved use of human and material resources in the areas of fiscal management, student recruitment, staffing, campus management, academic programing, and links with business,…

Nursing and the Management Function.

ERIC Educational Resources Information Center

Sherman, V. Clayton

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

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

The MAP Autonomous Mission Control System

NASA Technical Reports Server (NTRS)

Breed, Juile; Coyle, Steven; Blahut, Kevin; Dent, Carolyn; Shendock, Robert; Rowe, Roger

2000-01-01

The Microwave Anisotropy Probe (MAP) mission is the second mission in NASA's Office of Space Science low-cost, Medium-class Explorers (MIDEX) program. The Explorers Program is designed to accomplish frequent, low cost, high quality space science investigations utilizing innovative, streamlined, efficient management, design and operations approaches. The MAP spacecraft will produce an accurate full-sky map of the cosmic microwave background temperature fluctuations with high sensitivity and angular resolution. The MAP spacecraft is planned for launch in early 2001, and will be staffed by only single-shift operations. During the rest of the time the spacecraft must be operated autonomously, with personnel available only on an on-call basis. Four (4) innovations will work cooperatively to enable a significant reduction in operations costs for the MAP spacecraft. First, the use of a common ground system for Spacecraft Integration and Test (I&T) as well as Operations. Second, the use of Finite State Modeling for intelligent autonomy. Third, the integration of a graphical planning engine to drive the autonomous systems without an intermediate manual step. And fourth, the ability for distributed operations via Web and pager access.

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

PubMed

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

2016-12-16

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

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.

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.

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

PubMed Central

Mansdorf, B D

1975-01-01

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

10 CFR 719.12 - What information must be included in the Legal Management Plan?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false What information must be included in the Legal Management Plan? 719.12 Section 719.12 Energy DEPARTMENT OF ENERGY CONTRACTOR LEGAL MANAGEMENT REQUIREMENTS Legal Management Plan, Staffing and Resource Plan and Annual Legal Budget § 719.12 What information must be...

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...

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.

Managing Academic Libraries with Fewer Resources.

ERIC Educational Resources Information Center

Riggs, Donald E.

1992-01-01

A discussion of academic library management during retrenchment looks at a variety of issues, including staffing needs in the labor-intensive library environment, acquisitions budgeting, interlibrary cooperation (ownership vs. access to resources), entrepreneurship and strategic planning for problem solving, and use of total quality management…

15 CFR 291.2 - Environmental integration projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... Applicants should specify plans for proper organization, staffing, and management of the implementation... managing organization to conduct the proposed activities; qualifications of the project team and its... solicitation is permitted in this category. (b) Project objective. The purpose of these projects is to support...

15 CFR 291.3 - Environmental tools and techniques projects.

Code of Federal Regulations, 2011 CFR

2011-01-01

... demonstrated access to relevant technical or information sources external to the organization. (3) Degree of.... Applicants should specify plans for proper organization, staffing, and management of the implementation... managing organization to conduct the proposed activities; qualifications of the project team and its...

Internal Uses of the RLG Conspectus.

ERIC Educational Resources Information Center

Ferguson, Anthony W.; And Others

1987-01-01

Considers 10 areas of internal operations in which the Research Libraries Group/North American Collection Inventory Project (RLF/NCIP) Conspectus can be used as a management aid: collection priorities, collection management, space utilization, preservation programs, staffing allocations, material fund requests, accreditation, materials selection,…

48 CFR 1352.215-70 - Proposal preparation.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; justifications for noncompetitive proposed subcontracts; identification of technical data to be withheld; and any... evaluation factor.] Evaluation Factor 1—Technical Approach. Provide information on how the project is to be organized, staffed, and managed that demonstrates the offeror's understanding and effective management of...

76 FR 67228 - EMD Chemicals, Inc. Including On-Site Independent Contractors and Leased Workers From Ajilen...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-31

... Personnel, J&J Staffing, Accountemps/Robert Half, EMD Temps, Chromhelp, and Greentree Food Management... subject firm. The company reports that independent contract workers from Greentree Food Management were... Greentree Food Management working on-site at EMD Chemicals, Inc., Gibbstown, New Jersey. The amended notice...

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

PubMed

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

2009-07-01

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

Implementing Student Information Systems

ERIC Educational Resources Information Center

Sullivan, Laurie; Porter, Rebecca

2006-01-01

Implementing an enterprise resource planning system is a complex undertaking. Careful planning, management, communication, and staffing can make the difference between a successful and unsuccessful implementation. (Contains 3 tables.)

77 FR 42497 - Information Collection(s) Being Submitted for Review and Approval to the Office of Management and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-19

... officer (a post staffed 24 hours a day) in the FCC's Communications and Crisis Management Center in... Approval to the Office of Management and Budget (OMB) AGENCY: Federal Communications Commission. ACTION... comments to Nicholas A. Fraser, Office of Management and Budget (OMB), via fax at 202-395-5167 or via...

NREL Makes Key Appointments

Science.gov Websites

Makes Key Appointments Staffing for Distributed Energy and Tech Management Announced For more information contact: Gary Schmitz, 303-275-4050 email: Gary Schmitz Golden, Colo., Feb. 28, 2001 - Two reorganized Planning and Technology Management Division. Anthony Schaffhauser has been selected to become

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...

Improving transportation systems management and operations (TSM&O), capability maturity model workshop white paper : organization and staffing.

DOT National Transportation Integrated Search

2015-04-01

Research done through the Second Strategic Highway Research Program (SHRP 2) determined that agencies with the most effective transportation systems management and operations (TSM&O) activities were differentiated not by budgets or technical skills a...

78 FR 68037 - Membership of the National Telecommunications and Information Administration's Performance Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... Human Resources Management, Office of Executive Resources, 14th and Constitution Avenue NW., Room 51010... for Spectrum Management, Career SES Alan W. Vincent, Associate Administrator for Telecommunication..., Office of Staffing, Recruitment and Classification, Department of Commerce Human Resources Operations...

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

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.

HINTS Puerto Rico: Final Report

Cancer.gov

This final report describes HINTS implementation in Puerto Rico. The report addresses sampling; staffing, training and management of data collection; calling protocol; findings from the CATI Operations, and sample weights.

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.

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...

78 FR 68027 - Membership of the Bureau of Industry and Security Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

...: Ruthie B. Stewart, Department of Commerce, Office of Human Resources Management, Office of Executive..., Director, Office of Staffing, Recruitment and Classification, Department of Commerce Human Resources... the appointing authority on other performance management issues, such as pay adjustments, bonuses and...

Standards in Action. Using National Standards for Human Resource Management and Development in Further Education. 1. Laying the Foundations.

ERIC Educational Resources Information Center

Further Education Unit, London (England).

This booklet is designed to assist British further education college managers responsible for quality assurance, human resources management (HRM), human resources development (HRD), corporate development, strategic planning, staffing/personnel, and curriculum in using national standards for HRM and HRD in further education. A synopsis, users'…

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.

Assessment of DoD Wounded Warrior Matters -- Fort Riley

DTIC Science & Technology

2013-08-06

staffing levels, including squad leaders and Nurse Case Managers, are appropriate to meet the mission for effective management and support of Soldiers...military staff; physicians; nurses ; behavioral health specialists, such as psychologists and social workers; occupational therapists, including...primary mission – to heal and transition. The “Triad of Care” consists of a squad leader, a nurse case manager (NCM), and a primary care manager

Manager's handbook for software development, revision 1

NASA Technical Reports Server (NTRS)

1990-01-01

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

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.

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.

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…

Battle Cry of the Web Managers.

ERIC Educational Resources Information Center

Cornforth, Suzanne R.

1998-01-01

College and university Web site managers are offered advice for creative funding and staffing, including how to determine actual human, equipment, and financial resource needs; six ways to break out of the conventional funding paradigm (using existing resources well, using others' money, advertising, priority shifts, shared resources, and in-kind…

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)

77 FR 8279 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

..., 2010. Nevada Utilization Management Intake Division. 81,120 Euclid Industries Inc,, A Bay City, MI..., OR......... February 13, 2010. Holdings, Ltd (Portland Office), Argonaut Management Services Division... 13, 2010. Operations, Inc., Accounts Payable and Accounts Receivable, All Star Staffing Group. 81,151...

Nurse staffing and hospital ownership in California.

PubMed

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

2004-05-01

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

The diverse landscape of palliative care clinics.

PubMed

Smith, Alexander K; Thai, Julie N; Bakitas, Marie A; Meier, Diane E; Spragens, Lynn H; Temel, Jennifer S; Weissman, David E; Rabow, Michael W

2013-06-01

Many health care organizations are interested in instituting a palliative care clinic. However, there are insufficient published data regarding existing practices to inform the development of new programs. Our objective was to obtain in-depth information about palliative care clinics. We conducted a cross-sectional survey of 20 outpatient palliative care practices in diverse care settings. The survey included both closed- and open-ended questions regarding practice size, utilization of services, staffing, referrals, services offered, funding, impetus for starting, and challenges. Twenty of 21 (95%) practices responded. Practices self-identified as: hospital-based (n=7), within an oncology division/cancer center (n=5), part of an integrated health system (n=6), and hospice-based (n=2). The majority of referred patients had a cancer diagnosis. Additional common diagnoses included chronic obstructive pulmonary disease, neurologic disorders, and congestive heart failure. All practices ranked "pain management" and "determining goals of care" as the most common reasons for referrals. Twelve practices staffed fewer than 5 half-days of clinic per week, with 7 operating only one half-day per week. Practices were staffed by a mixture of physicians, advanced practice nurses or nurse practitioners, nurses, or social workers. Eighteen practices expected their practice to grow within the next year. Eleven practices noted a staffing shortage and 8 had a wait time of a week or more for a new patient appointment. Only 12 practices provide 24/7 coverage. Billing and institutional support were the most common funding sources. Most practices described starting because inpatient palliative providers perceived poor quality outpatient care in the outpatient setting. The most common challenges included: funding for staffing (11) and being overwhelmed with referrals (8). Once established, outpatient palliative care practices anticipate rapid growth. In this context, outpatient practices must plan for increased staffing and develop a sustainable financial model.

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.

Human Resource Management in Hong Kong Preschools: The Impact of Falling Rolls on Staffing

ERIC Educational Resources Information Center

Ho, Choi-Wa Dora

2009-01-01

Purpose: The purpose of this paper is to discuss the impact of falling rolls on human resource management in local preschools in Hong Kong. It aims to argue that the developing role of leadership in creating a culture and procedures for collective participation in staff appraisal is important for human resource management in preschool settings.…

Doing more with less in nursing work: a review of the literature.

PubMed

Bradley, C

1999-09-01

The paper explores the literature on changes in nursing work. It examines the suggestion that changes in work practices are management responses to cost cutting imperatives. Nursing labour force issues such as staffing roles and staffing mix, the push for flexibility in the workforce and casualisation are discussed. The paper concludes that given the rise of casual work in the general Australian workforce, research needs to be conducted on the extent of casualisation of nursing, and the implications this may have for nursing practice, professional development and on the nursing labour market.

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.

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.

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...

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)

Forecasting staffing needs for productivity management in hospital laboratories.

PubMed

Pang, C Y; Swint, J M

1985-12-01

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

The Oklahoma bombing. Lessons learned.

PubMed

Anteau, C M; Williams, L A

1997-06-01

The Oklahoma City bombing experience in April of 1995 provided a unique opportunity to test the effectiveness of an existing disaster plan. The critical care nurses at Columbia Presbyterian Hospital learned valuable lessons about managing intense activity, equipment and supplies, staffing resources, and visitor issues. The degree to which the bombing affected the emotional state of personnel was unanticipated, and leaders learned that critical stress management interventions should be included in every emergency preparedness plan. Additionally, recommendations include using runners for communication; assigning specific roles (supplies, staffing, triage); keeping additional staff in reserve for shift relief; ensuring ample hospital staff members are available to coordinate visitors and media; and setting up record systems to preserve continuity. The unique lessons learned as a result of this terrorist attack can be used by other critical care nurses to understand and refine disaster plans.

Managing Technology Resourcefully: Part II--Working with Your District's Technology

ERIC Educational Resources Information Center

Weeks, Richard

2009-01-01

A large school district may have a technology department staffed by a chief technology officer who supervises two or more directors of operations, project managers, and technicians. On the other hand, a small district may employ an information technologist who works with technicians, consultants, volunteers with a knack for technology, and…

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...

Managing Smallness: Promising Fiscal Practices for Rural School District Administrators.

ERIC Educational Resources Information Center

Freitas, Deborah Inman

Based on a mail survey of over 100 rural school administrators in 34 states, this handbook outlines common problems and successful strategies in the financial management of rural, small school districts. Major problems are related to revenue and cash flow, increasing expenditures, providing quality education programs, and staffing to handle the…

The effects of organizational flexibility on nurse utilization and vacancy statistics in Ontario hospitals.

PubMed

Fisher, Anita; Baumann, Andrea; Blythe, Jennifer

2007-01-01

Social and economic changes in industrial societies during the past quarter-century encouraged organizations to develop greater flexibility in their employment systems in order to adapt to organizational restructuring and labour market shifts (Kallenberg 2003). During the 1990s this trend became evident in healthcare organizations. Before healthcare restructuring, employment in the acute hospital sector was more stable, with higher levels of full-time staff. However, in the downsizing era, employers favoured more flexible, contingent workforces (Zeytinoglu 1999). As healthcare systems evolved, staffing patterns became more chaotic and predicting staffing requirements more complex. Increased use of casual and part-time staff, overtime and agency nurses, as well as alterations in skills mix, masked vacancy counts and thus rendered this measurement of nursing demand increasingly difficult. This study explores flexible nurse staffing practices and demonstrates how data such as nurse vacancy statistics, considered in isolation from nurse utilization information, are inaccurate indicators of nursing demand and nurse shortage. It develops an algorithm that provides a standard methodology for improved monitoring and management of nurse utilization data and better quantification of vacancy statistics. Use of standard methodology promotes more accurate measurement of nurse utilization and shortage. Furthermore, it provides a solid base for improved nursing workforce planning, production and management.

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

Practice Leadership at the Front Line in Supporting People with Intellectual Disabilities and Challenging Behaviour: A Qualitative Study of Registered Managers of Community-Based, Staffed Group Homes

ERIC Educational Resources Information Center

Deveau, Roy; McGill, Peter

2016-01-01

Background: The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour. Method: Interviews, primarily focussed upon staff…

Management Education in Public Health: Further Considerations

PubMed Central

Darr, Kurt J.

2015-01-01

Knowing and applying the basic management functions of planning, organizing, staffing, directing, and controlling, as well as their permutations and combinations, are vital to effective delivery of public health services. Presently, graduate programs that prepare public health professionals neither emphasize teaching management theory, nor its application. This deficit puts those who become managers in public health and those they serve at a distinct disadvantage. This deficit can be remedied by enhanced teaching of management subjects PMID:26673475

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...

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

PubMed

Ryan, Mary Jane

2005-01-01

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

75 FR 45557 - Prevailing Rate Systems; Definition of Tulsa County, OK, and Angelina County, TX, to...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

.... Veterans Canteen Service (VCS) now operates franchise coffee bars, staffed with NAF employees, at..., Government employees, Reporting and recordkeeping requirements, Wages. U.S. Office of Personnel Management...

Evaluating the link between human resource management decisions and patient satisfaction with quality of care.

PubMed

Oppel, Eva-Maria; Winter, Vera; Schreyögg, Jonas

Patient satisfaction with quality of care is becoming increasingly important in the competitive hospital market. Simultaneously, the growing shortage of clinical staff poses a considerable challenge to ensuring a high quality of care. In this context, a question emerges regarding whether and how human resource management (HRM) might serve as a means to reduce staff shortage problems and to increase patient satisfaction. Although considerable efforts have been devoted to understanding the concepts of patient satisfaction and HRM, little is known about the interrelationships between these concepts or about the link between staff shortage problems and patients' satisfaction with quality of care. The aim of this study was to investigate the relationship between strategic human resource management (SHRM), staff shortage problems, and patients' satisfaction with care. Furthermore, we analyze how the HRM decision to fill short-term vacancies through temporary staffing affects patient satisfaction. We differentiate between physicians and nurses. We develop and empirically test a theoretical model. The data (n = 165) are derived from a survey on SHRM that was sent to 732 German hospitals and from a survey on patient satisfaction that comprises 436,848 patient satisfaction ratings. We use a structural equation modeling approach to test the model. The results indicate that SHRM significantly reduces staff shortage problems for both occupational groups. Having fewer physician shortage problems is significantly associated with higher levels of patient satisfaction, whereas this effect is not significant for nurses. Furthermore, the use of temporary staffing considerably reduces patients' satisfaction with care. Hospital managers are advised to consider the effects of HRM decisions on patients' satisfaction with care. In particular, investments in SHRM targeted at physicians have significantly positive effects on patient satisfaction, whereas the temporary staffing of physicians and nurses should be avoided.

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

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.

Proceedings of the Annual Eastern Michigan University Conference on Languages for Business and the Professions (7th, Ann Arbor, Michigan, April 7-9, 1988).

ERIC Educational Resources Information Center

Des Harnais, Gaston, Ed.

Eighty-nine conference papers are presented in 10 sections: (1) language and cultural factors in conducting international business (qualifications for success as an international manager, staffing of international departments, role of second language proficiency, and international management concepts); (2) interdisciplinary language and business…

Choosing a Digital Asset Management System That's Right for You

ERIC Educational Resources Information Center

Kaplan, Deborah

2009-01-01

Planning is necessary in selecting the appropriate digital asset management system for your institution. Key issues one should consider in planning: the objects to be stored, where they come from, and how they will be accessed; the end users; and the needed staffing levels for system maintenance. During the development of the system requirements,…

A Positive Approach to Change: The Role of Appreciative Inquiry in Library and Information Organisations

ERIC Educational Resources Information Center

Kelly, Tricia

2010-01-01

Library and information management (LIM) organisations are on an almost continual path of change driven by changes in technology, service models, staffing structures, and financial allocations. The way in which LIM organisations approach change varies, as does the success rate of change management procedures undertaken. One particular approach to…

The reality of task shifting in medicines management- a case study from Tanzania.

PubMed

Wiedenmayer, Karin A; Kapologwe, Ntuli; Charles, James; Chilunda, Fiona; Mapunjo, Siana

2015-01-01

Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls.The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. We explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice. A cross-sectional study was conducted in 270 public health facilities in 2011. A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks. Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed. While required staffing levels in 1999 were 50, the region employed a total of only 14 pharmaceutical staff in 2011. Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. The first training on supply management was provided in 2005 with no refresher training thereafter. Mean availability of tracer medicines was 53%, while 56% of health facilities fully met criteria of Good Storage Practice. Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. In Dodoma Region, pharmacy-related tasks and supply management have informally been shifted to clinical staff without policy guidance, explicit job descriptions, and without the necessary support through training. Implicit task shifting should be recognized and formalized. Job orientation, training and operational procedures may be useful to support non-pharmaceutical health workers to effectively manage medicine supply.

Independent practice association physician groups in California.

PubMed

Grumbach, K; Coffman, J; Vranizan, K; Blick, N; O'Neil, E H

1998-01-01

We surveyed independent practice association (IPA) physician groups in California about their approaches to staffing, physician payment, and governance. Most IPAs desired more primary care physicians but not more specialists. Capitation was the major mode of remuneration for primary care physicians in 77 percent of IPAs, and for specialists in 30 percent of IPAs. Most IPAs also used financial incentives related to use of referral or ancillary services. Boards of directors were dominated by physicians, but governance tended to be centralized rather than highly democratic. We found that IPAs mirror many of the broader trends in physician staffing and physician payment that exist in managed care organizations.

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.

75 FR 62425 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

... August 27, 2009. Workers Express Employment Professionals, Contemporary Staffing, etc. 74,586 Burton... date 74,062 EPSG Management Services Burbank, CA 74,430 Tasman Hartford, LLC.... Hartford, WI I hereby...

Regional economic effects of current and proposed management alternatives for Arrowwood National Wildlife Refuge

USGS Publications Warehouse

Koontz, Lynne; Lambert, Heather

2005-01-01

This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

USGS Publications Warehouse

Koontz, Lynne; Lambert, Heather

2005-01-01

This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

Contingency Base Camp Operations and Management: Staffing and Organization

DTIC Science & Technology

2013-09-17

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

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

Nursing Home Staffing Standards: Their Relationship to Nurse Staffing Levels

ERIC Educational Resources Information Center

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

2006-01-01

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

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

Campus Network Strategies: A Small College Perspective.

ERIC Educational Resources Information Center

Moberg, Thomas

1999-01-01

Offers advice to administrators and faculty in small colleges on planning, building, and managing campus computer networks. Also included are observations about the network as a strategic asset, funding and staffing issues, and planning for unexpected results. (Author/MSE)

The 10 Dimensions of Employee Involvement.

ERIC Educational Resources Information Center

Magjuka, Richard J.

1993-01-01

A survey of 923 employee involvement programs (57%) yielded 10 themes: range of problem content, team staffing, team membership status, team resources, training practices, information access, financial rewards, performance management systems, goal-setting structures, and roles of job supervisors. (JOW)

5 CFR 370.102 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... PROGRAM § 370.102 Definitions. In this part: Agency means an Executive agency as defined in 5 U.S.C. 105... planning, organizing, staffing, directing, integrating, or controlling of information technology as defined... acquisition, storage, manipulation, management, movement, control, display, switching, interchange...

5 CFR 370.102 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... PROGRAM § 370.102 Definitions. In this part: Agency means an Executive agency as defined in 5 U.S.C. 105... planning, organizing, staffing, directing, integrating, or controlling of information technology as defined... acquisition, storage, manipulation, management, movement, control, display, switching, interchange...

5 CFR 370.102 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... PROGRAM § 370.102 Definitions. In this part: Agency means an Executive agency as defined in 5 U.S.C. 105... planning, organizing, staffing, directing, integrating, or controlling of information technology as defined... acquisition, storage, manipulation, management, movement, control, display, switching, interchange...

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.

Towards a Model of School Leadership.

ERIC Educational Resources Information Center

Busher, Hugh; Saran, Rene

1994-01-01

Explores the various leadership models (structural-functional, open-systems, cultural-pluralism, interpersonal, and political) used to illuminate headteachers' work and considers the problems faced by leaders in professionally staffed organizations. School leadership activities center on managing organizational cultures and the external…

Institutional Research.

ERIC Educational Resources Information Center

Olsen, Deborah

2000-01-01

Discusses institutional research (IR) in higher education, which is designed to generate information that serves planning, policy development, resource allocation, and management or evaluation decisions in all functional areas. Addresses its history, the skills and training needed by researchers, structure and staffing, and professional…

Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey.

PubMed

Yokoyama, Mami; Suzuki, Miho; Takai, Yukari; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yamamoto-Mitani, Noriko

2016-09-01

To explore the association between workplace bullying and workplace environment factors among nurses in Japan. Workplace bullying among nurses is increasing globally and occurs more frequently than among other professions. However, there is little information on the impact of workplace environment factors on nurse bullying in Japan. A cross-sectional survey using a self-administered questionnaire. Participants were 1152 nurses recruited at seminars or training courses outside of their workplaces in Tokyo. Workplace bullying was measured using the Negative Acts Questionnaire-Revised. Participants were considered to have been 'bullied' if they reported experiencing at least one negative act on a daily or weekly basis. Workplace environment factors were measured using the Practice Environment Scale of the Nursing Work Index, which comprises five domains: nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership and support of nurses; staffing and resource adequacy; and collegial nurse-physician relationships. A total of 898 (78·0%) questionnaires were returned, of which 825 (71·6%) were analysed. Altogether, 153 (18·5%) nurses were considered 'bullied.' The three most frequent negative acts reported as occurring on a weekly or daily basis were 'someone withholding information which affects your performance' (6·7%), 'being exposed to an unmanageable workload' (4·4%) and 'being shouted at or being the target of spontaneous anger (or rage)' (3·6%). Logistic regression analysis indicated that 'bullied' were associated with low scores on two work environment domains: nurse manager ability, leadership and support of nurses and staffing and resource adequacy. Effective nurse manager leadership and support as well as appropriate staffing management may positively influence workplace bullying among nurses in Japan. Authentic leadership styles and allowing nurses to easily request days off might also be important. Nurse managers' leadership may influence nurses' workplace bullying. © 2016 John Wiley & Sons Ltd.

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

PubMed

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

2015-08-07

Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway. www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

PubMed

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (<300 annual births) and 49% were high volume (≥300 annual births). Among low-volume hospitals, 78% used a shared nurse staff model. In contrast, 31% of high-volume hospitals used a shared nurse staff model. Respondents praised the teamwork, dedication, and skill of their maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2008-01-01

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

A Secondary Analysis of the Impact of School Management Practices on School Performance

ERIC Educational Resources Information Center

Talbert, Dale A.

2009-01-01

The purpose of this study was to conduct a secondary analysis of the impact of school management practices on school performance utilizing a survey design of School and Staffing (SASS) data collected by the National Center for Education Statistics (NCES) of the U.S. Department of Education, 1999-2000. The study identifies those school management…

A Survey of UK University Web Management: Staffing, Systems and Issues

ERIC Educational Resources Information Center

Cox, Andrew; Emmott, Stephen

2007-01-01

Purpose: The purpose of the paper is to summarize the findings of a survey of UK universities about how their websites are managed and resourced, which technologies are in use, and what are seen as the main issues and priorities. Design/methodology/approach: The paper is based on a web-based questionnaire distributed in summer 2006, which received…

An Analysis of Studies on Effectiveness of Training and Staffing to Help Schools Manage Student Conflict and Alienation. A Report.

ERIC Educational Resources Information Center

Hyman, Irwin A.

A search of the literature was made on the effectiveness of recruitment and selection procedures for identifying and retaining administrators and school staff who are effective in managing student conflict and alienation. A classification scheme devised to fit approaches to school discipline within a theoretical framework includes (1) the…

A survey of pandemic influenza preparedness and response capabilities in Chicago area hospital security departments.

PubMed

Kimmerly, David P

2009-01-01

This article is a summary based on a December 2007 paper prepared by the author in partial fulfillment of the requirements for a master's degree in business and organizational security management at Webster University. The project described was intended to assess Chicago-area healthcare organization security departments' preparedness and response capabilities for a potential influenza pandemic. While the author says healthcare organizations are learning from the pandemics of the past, little research has been conducted on the requirements necessary within hospital security departments. The article explores staffing, planning, preparation and response capabilities within a healthcare security context to determine existing resources available to the healthcare security community. Eleven completed surveys were received from hospital security managers throughout the geographical Chicago area. They reveal that hospital security managers are conscious of the risks of a pandemic influenza outbreak. Yet, it was found that several gaps existed within hospital security department staffing and response capabilities, as hospital security departments may not have the available resources necessary to adequately maintain their operations during a pandemic incident.

Measuring nursing essential contributions to quality patient care outcomes.

PubMed

Wolgast, Kelly A; Taylor, Katherine; Garcia, Dawn; Watkins, Miko

2011-01-01

Workload Management System for Nursing (WMSN) is a core Army Medical Department business system that has provided near real-time, comprehensive nursing workload and manpower data for decision making at all levels for over 25 years. The Army Manpower Requirements and Documentation Agency populates data from WMSN into the Manpower Staffing Standards System (Inpatient module within Automated Staffing Assessment Model). The current system, Workload Management System for Nursing Internet (WMSNi), is an interim solution that requires additional functionalities for modernization and integration at the enterprise level. The expanding missions and approved requirements for WMSNi support strategic initiatives on the Army Medical Command balanced scorecard and require continued sustainment for multiple personnel and manpower business processes for both inpatient and outpatient nursing care. This system is currently being leveraged by the TRICARE Management Activity as an interim multiservice solution, and is being used at 24 Army medical treatment facilities. The evidenced-based information provided to Army decision makers through the methods used in the WMSNi will be essential across the Army Medical Command throughout the system's life cycle.

What You Always Wanted to Know About Monitoring Naval Ship Construction but You Did Not Dare Ask.

DTIC Science & Technology

1990-06-01

CONCEPTUAL DESIGN For the conceptual design of the management efforts, we quote the Principles of Management , as they were presented by Fayol (Ret. l:p...functional groups. The five basic principles of management theory are: Planning, Organizing, Staffing, Directing, and Controlling. These principles... Principles of Management , McGraw-Hill, 1978. 16. ibid. 70 17. ibid. 18. ibid. 19. ibid. 20. Wolfe, P.M., Cochran E.B., and Thompson, W.J., A BERTS- Based

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.

34 CFR 200.43 - Restructuring.

Code of Federal Regulations, 2010 CFR

2010-07-01

...— (1) Makes fundamental reforms to improve student academic achievement in the school; (2) Has..., such as a private management company, with a demonstrated record of effectiveness, to operate the... arrangement that makes fundamental reforms, such as significant changes in the school's staffing and...

Relational Data Bases--Are You Ready?

ERIC Educational Resources Information Center

Marshall, Dorothy M.

1989-01-01

Migrating from a traditional to a relational database technology requires more than traditional project management techniques. An overview of what to consider before migrating to relational database technology is presented. Leadership, staffing, vendor support, hardware, software, and application development are discussed. (MLW)

77 FR 53913 - Accellent

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

...-Site Leased Workers From Aerotek, Corporate Management Group (CMG), Marathon Staffing, And Excel... leased from Excel Personnel, Inc. were employed on-site at the Englewood, Colorado location of Accellent... certification to include workers leased from Excel Personnel, Inc. working on-site at the Englewood, Colorado...

Aviation Safety: Opportunities Exist for FAA to Refine the Controller Staffing Process

DOT National Transportation Integrated Search

1997-04-09

The Federal Aviation Administration (FAA) is responsible for managing the : nation's air transportation system so more than 18,000 aircraft can annually : carry 500 million passengers safely and on schedule. Because of significant : hiring in the ear...

"The Prognosis, Doctor?"

ERIC Educational Resources Information Center

Everhart, Nancy

1998-01-01

Updates a 1994 report on school library staffing, highlighting states with the best and worst student/librarian ratios, states requiring full-time certified library media specialists, states with site-based management, states replacing librarians with technology specialists. Lists states requiring full-time specialists for elementary,…

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...

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.

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

PubMed

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

2006-12-01

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

A helicopter emergency medical service may allow faster access to highly specialised care.

PubMed

Afzali, Monika; Hesselfeldt, Rasmus; Steinmetz, Jacob; Thomsen, Annemarie Bondegaard; Rasmussen, Lars S

2013-07-01

Centralization of the hospital system entails longer transport for some patients. A physician-staffed helicopter may provide effective triage, advanced management and fast transport to highly specialized treatment for time-critical patients. The aim of this study was to describe activity and possible beneficial effect of a physician-staffed helicopter in a one-year trial period in eastern Denmark. This was a prospective observational study of all missions related to a daylight operating, physician-staffed helicopter. We recorded information about the activity during 12 months, focusing on dispatchment, diagnoses, medical interventions, admission patterns and 30-day mortality. There were a total of 574 missions resulting in 609 patient contacts. Activity ranged from 22 to 76 missions per month. The helicopter was grounded 6% of its operating time, mainly due to weather conditions. The primary patient categories were trauma (43.5%) and cardiac disease (26.1%). The physician acted as Medical Incident Officer at three major incidents. A total of 53 endotracheal intubations, 13 intraosseous cannula insertions and four tube thoracostomies were performed. The median hospital length-of-stay was four days, 30-day mortality was 6.1% and 86 patients were transferred to intensive care units. The physician-staffed helicopter had approximately two missions per day the first year, mainly in relation to trauma and cardiac patients needing specialized treatment. Advanced medical interventions were commonly performed. Funded by Trygfonden. not relevant.

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

PubMed Central

Bowblis, John R; Hyer, Kathryn

2013-01-01

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

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

PubMed

Bowblis, John R; Hyer, Kathryn

2013-08-01

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

East Asian Collections and Organizational Transformation in Academic Libraries.

ERIC Educational Resources Information Center

Kamada, Hitoshi

2002-01-01

Discusses special aspects of East Asian collections and explores how organizational changes in academic libraries affect them, based on experiences at the University of Arizona. Considers total quality management; continuous quality improvement; teamwork; staffing changes; specialization versus generalization; budgetary restraints and cost…

5 CFR 9901.502 - Scope of authority.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Staffing and Employment General § 9901.502 Scope of authority. When a specified category of employees, applicants, and positions is covered by the system established under this subpart...

36 CFR 1008.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... photograph. Related definitions include: (1) System of records means a group of any records under the control... means records used for personnel management programs or processes such as staffing, employee development, retirement, and grievances and appeals. (4) Statistical records means records in a system of records...

42 CFR 9.9 - Facility staffing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... provide appropriate care to the chimpanzees at all times, including evenings, weekends, and holidays. The... socialization techniques. In addition, the Director must have management and administrative experience; (d) The... chimpanzees is desirable; (e) The remaining staff, which may include part-time, full-time, or contractor...

GWOT Vascular Injury Study 2 Supplemental Project: Impact of Prophylactic Fasciotomy

DTIC Science & Technology

2017-10-01

of the project ? The overall goal is to determine the impact of the widespread use of fasciotomies on current medical/surgical practices, management ...Diane Miller Project Role: Program Manager Nearest person month worked: 12 Contribution to Project : Ms. Miller is responsible for the day-to-day...each branch of service. Goals/Milestones CY14 Goal – Protocol/Staffing  Write and submit protocol to IRB  Hire project manager CY15 Goals – Data

Manual of Documentation Practices Applicable to Defence-Aerospace Scientific and Technical Information. Volume 1. Section 1 - Acquisition and Sources. Section 2 - Descriptive Cataloguing. Section 3 - Abstracting and Subject Analysis

DTIC Science & Technology

1978-08-01

weeding I I ORGANISATION & MANAGEMENT Aims and objectives, staffing, promotional activities, identifying u;ers 12 NETWORKS & EXTERNAL SOURCES OF...Acquisition Clerks with typing capability are required for meticulous recordkeeping. Typing capability of 50 words per minute and a working knowledge ...81 Adminhistration and Management Includes management planning and research. 64 Numerical Analysis Includes iteration, difference equations, and 82

Remote sensing training for Corps of Engineering personnel: The university training module concept

NASA Technical Reports Server (NTRS)

1982-01-01

A concept to permit Corps of Engineers personnel to obtain and maintain an appropriate level of individual proficiency in the application of remote sensing to water resource management is described. Recommendations are made for specific training courses and include structure and staffing requirements, syllabi and methods of operation, supporting materials, and procedures for integrating information systems management into the University Training Modules.

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.

Responding to traveling patients' seasonal demand for health care services.

PubMed

Al-Haque, Shahed; Ceyhan, Mehmet Erkan; Chan, Stephanie H; Nightingale, Deborah J

2015-01-01

The Veterans Health Administration (VHA) provides care to over 8 million Veterans and operates over 1,700 sites of care across 21 regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in the southern United States because of arrival of "snowbirds" during the winter. Because resource allocation activities are primarily carried out through an annual budgeting process, the seasonal load imposed by "traveling Veterans"-Veterans that seek care at VHA sites outside of their home network-make providing high-quality services more challenging. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We discovered strong seasonal fluctuations in demand at a clinic located in the southeastern United States and developed a seasonal autoregressive integrated moving average model to help the clinic forecast demand for its services with significantly less error than historical averaging. Monte Carlo simulation of the clinic revealed that physicians are overutilized, suggesting the need to re-evaluate how the clinic is currently staffed. More broadly, this study demonstrates how operations management methods can assist operational decision making at other clinics and medical centers both within and outside VHA. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

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

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.

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...

A Survey Report of School Plant Management for Escambia County, Florida.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee.

This report analyzes data collected by survey teams concerned with maintenance and operation of school plants in relation to organization, administration, budgeting, expenditures, purchasing, staffing, warehousing and distribution, maintenance shops, administrative practices, performance standards, and efficiency. The basic purposes of a…

Truth or Consequence

ERIC Educational Resources Information Center

Tolson, Stephanie D.

2005-01-01

Staffing, recruitment and retention, and staff development will become more challenging as resources shrink in community college libraries. Technical skills such as website development, systems maintenance, and the ability to support students and faculty using course management systems will become more specialized and may be found in staff other…

25 CFR 700.257 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... under the control of the Commission from which information is retrieved by the name of the individual or... Commission by the Commission and used for personnel management programs or processes such as staffing, employee development, retirement, and grievances and appeals. (h) Statistical records. As used in this...

43 CFR 2.46 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... group of any records under the control of the Department or a bureau thereof from which information is... management programs or processes such as staffing, employee development, retirement, and grievances and appeals. (i) Statistical records. As used in this subpart, “statistical records” means records in a system...

Applications experiments in the Houston region

NASA Technical Reports Server (NTRS)

Erb, R. B.

1972-01-01

Organization, staffing, and planning for experimental applications of remote sensing data to gain land use and water management information are described. Work was started on an experimental data base, aerial multispectral photography, and forest and wild life surveys as part of a regional inventory and monitory program.

Off-Site Indexing: A Cottage Industry.

ERIC Educational Resources Information Center

Fay, Catherine H.

1984-01-01

Briefly describes use of off-site staffing--indexers, abstractors, editors--in the production of two major databases: Management Contents and The Computer Data Base. Discussion covers the production sequence; database administrator; off-site indexer; savings (office space, furniture and equipment costs, salaries, and overhead); and problems…

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,…

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.

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.

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.

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.

Total Quality Management: Will It Work in the System Program Office?

DTIC Science & Technology

1990-05-01

Quality Management (TQM) is a relatively new philosophy of management which has high-level Department of Defense support and is presently being implemented in the Air Force. In the Air Force Systems Command, weapon system development and acquisition are carried out in System Program Offices (SPOs), staffed with various functionally oriented specialists supplied to the System Program Director by functional ’home offices’ via a matrix management scheme. Can TQM, relying as it does on cross-functional cooperation and on processes which cross functional lines, be

Simulation modeling for the health care manager.

PubMed

Kennedy, Michael H

2009-01-01

This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

The DISAM Journal of International Security Assistance Management. Volume 23, Number 1, Fall 2000

DTIC Science & Technology

2000-01-01

Security Assistance Command Figure 1 The USASAC, including OPM-SANG, is staffed by 621 men and women , of whom 104 are military. These professionals are...by program managers. These program managers are like “front-line entreprenuers ” delivering products and services to their customers. They have been...NATO history was to be commanded by a Polish general in June 1988. The brigade of some 3000 men and women was composed of five national battalions

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.

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.

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

Using patient acuity data to manage patient care outcomes and patient care costs.

PubMed

Van Slyck, A; Johnson, K R

2001-01-01

This article describes actual reported uses for patient acuity data that go beyond historical uses in determining staffing allocations. These expanded uses include managing patient care outcomes and health care costs. The article offers the patient care executive examples of how objective, valid, and reliable data are used to drive approaches to effectively influence decision making in an increasingly competitive health care environment.

A Comparative Assessment of Knowledge Management Education Across the United States Department of Defense

DTIC Science & Technology

2007-03-01

portal, AKO. The Army is also creating Battle Command Knowledge Cells staffed with Knowledge Management Officers ( KMO ) to facilitate KM within...battle commands. To increase their effectiveness, the Army has a draft Standard Operation Procedures (SOP) document to assist KMOs in establishing and...cultivating KM programs. This draft document includes instruction on implementing a KM program in a unit, worksheets to assist KMOs with knowledge

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.

[Fibrinolysis and acute stroke in maritime search and rescue medical evacuation].

PubMed

Lambert, R; Cabardis, S; Valance, J; Borge, E; Ducassé, J-L; Arzalier, J-J

2008-03-01

Medical management of a female passenger with acute stroke aboard a cruise ship at the sea allowed a fast evacuation towards a stroke unit by an helicopter staffed with an emergency medical doctor. Fibrinolysis begun in a short delay after magnetic resonance imaging.

78 FR 61392 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

..., Hartford, CT. Inc., Corporate/Finance/ Controllers. The following determinations terminating investigations... Staffing, Employee Management, CBS Personnel, etc. 82,977 Pall Corporation, Finance Port Washington, NY..., Greensboro, NC. Finance Department, Novartis AG, ProUnlimited. 82,984 The Berry Company, LLC Rochester, NY...

Arkansas' Junior Executive Training Curriculum Guide.

ERIC Educational Resources Information Center

Clayton, Dean; And Others

This curriculum guide is designed to help teachers conduct courses on small business management and entrepreneurship to high school seniors in Arkansas. The program focuses upon the managerial process, examining the functions of planning, organization, staffing, directing, and controlling as related to the activities and responsibilities of the…

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...

Web Team Development

ERIC Educational Resources Information Center

Church, Jennifer; Felker, Kyle

2005-01-01

The dynamic world of the Web has provided libraries with a wealth of opportunities, including new approaches to the provision of information and varied internal staffing structures. The development of self-managed Web teams, endowed with authority and resources, can create an adaptable and responsive culture within libraries. This new working team…

76 FR 62083 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-06

... organizational changes in the National Institute on Minority Health and Health Disparities (NIMHD). Section N-B... personnel and staffing, purchase and maintenance of equipment and supplies, and acquisition and management...- based resource for information and research findings on minority health and health disparities...

76 FR 64072 - Membership of the Bureau of Industry and Security Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

...: Ruthie B. Stewart, Department of Commerce Human Resources Operations Center (DOCHROC), Office of Staffing..., and Classification, Department of Commerce Human Resources Operations Center. [FR Doc. 2011-26740... the appointing authority on other performance management issues, such as pay adjustments, bonuses and...

[Research on competency building standards of institutions of schistosomiasis prevention and control in Hubei Province I Investigation of institution management].

PubMed

Liu, Han-cheng; Zhong, Chen-hui; Liao, Si-qi; He, Hui

2014-08-01

To investigate the current situation of management of institutions of schistosomiasis prevention and control in Hubei Province, so as to explore the probable competency building standards for these institutions at the county and township levels. By using a combination of quantitative and qualitative methods, the institutions of schistosomiasis prevention and control at county and township levels were investigated for the institutional setup, staffing and fulfillment functions since the reform of 2004. Among 63 schistosomiasis endemic counties (cities, districts) of Hubei Province, there were 26 independent schistosomiasis control institutions (41.27%), there were 24 institutions which were incorporated into CDC (38.10%), and there were no institutions in 13 counties (20.63%). Among 518 endemic towns, there were 299 institutions (57.72%). The total staffing size were 1 932, but there were 1 586 (82.09%) people actually working in the post, and therefore there were 346 (17.91%) empty positions. The average rates of carrying out the six functions were 91.48%-71.19%, but only 19.23% of the institutions participated in the comprehensive schistosomiasis control management project and its effect assessment. According to the management model for schistosomiasis control institutions under the current institutional mechanisms, we need a rigorous industry standard to constrain, guide and standardize the management and capacity-building of the institutions in different historical periods.

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.

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

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

How do I manage and staff for intelligent transportation systems? : thinking outside the box : a cross-cutting study : maximizing project resources and advancing coordination

DOT National Transportation Integrated Search

2000-08-01

Intelligent transportation systems (ITS) projects often need staff with skills that are not resident in traditional transportation organizations. Therefore, project administrators must sometimes look beyond the usual staffing methods to fill these po...

British University Libraries 1977-1987: Some Observations on the Challenges of Declining Resources.

ERIC Educational Resources Information Center

Rodger, Elizabeth M.

1988-01-01

Highlights some of the developments in the following areas that have taken place during the period 1977-87 in British university libraries: (1) library resources; (2) automation; (3) collection building; (4) technical services; (5) reader services; (6) management and staffing; and (7) cooperation. (71 references) (MES)

75 FR 9437 - Wacker Chemical Corporation Wacker Polymers Division a Subsidiary of Wacker Chemie AG Including...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... Chemical Corporation Wacker Polymers Division a Subsidiary of Wacker Chemie AG Including On-Site Leased.... and Yoh Managed Staffing South Brunswick, NJ; Wacker Chemical Corporation Wacker Polymers Division a... of Wacker Chemical Corporation, Wacker Polymers Division, a subsidiary of Wacker Chemie AG, including...

Computer Aided Reference Services in the Academic Library: Experiences in Organizing and Operating an Online Reference Service.

ERIC Educational Resources Information Center

Hoover, Ryan E.

1979-01-01

Summarizes the development of the Computer-Aided Reference Services (CARS) division of the University of Utah Libraries' reference department. Development, organizational structure, site selection, equipment, management, staffing and training considerations, promotion and marketing, budget and pricing, record keeping, statistics, and evaluation…

Time off is crucial.

PubMed

Arif, Zeba

2016-10-05

Most nurses are contracted to work 37.5 hours over five days, followed by two days off. But many areas of the health service are so short staffed that split days off, where nurses do not get two consecutive days off, are becoming more common as managers struggle to provide cover for shifts.

Program to Combat Stereotyping in Career Choice.

ERIC Educational Resources Information Center

Harrison, Laurie R.

Divided into three sections which deal with sex, race, and handicap stereotyping in career choice, the twenty-eight programs described here attempt to combat stereotypes among students and/or staff (K-12). Most descriptions list the goals of the program, target population, staffing and management, facilities and activities, program effectiveness…

Engineering Management for Zone Construction of Ships

DTIC Science & Technology

1985-09-01

Theory has steadily developed along with the better understanding of human relations, moti- vation and worklife sciences. That this is so, is clear from a...will not accomplish its goals effectively and efficiently if it is not staffed with the correct number of people with the correct balance of education

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)

Managing Student Study Time.

ERIC Educational Resources Information Center

Hudson, H. T.

1981-01-01

Large lecture sections of science staffed by a single instructor make it impossible to provide individual student attention and lead to high dropout and failure rates. Daily assignments are used to encourage students to identify areas that need remediation, maintain a steady study pace, receive positive reinforcement, and learn methods of solving…

Implications for Higher Education of the Public Sector Reform Agenda.

ERIC Educational Resources Information Center

Coaldrake, Peter

1995-01-01

It is argued that issues of accountability, competition, the technology, and internationalization of education suggest it is in the best interest of Australian higher education to adopt strategic management techniques being promoted for the public sector. This includes new emphases on staffing policies and practices, resource allocation and…

Office Organization and Procedures in the Office--Calendar; Commencement Procedure; Publications; Records; Registration; Reports; Scheduling; Staffing; Testing; Transcripts

ERIC Educational Resources Information Center

College and University, 1977

1977-01-01

Proceedings of AACRAO's 63rd annual meeting cover: calendar conversion; publications economy; class schedules; fraudulent transcripts; student retention; student ID numbers; veteran student reporting; financial aid reporting; faculty activity analyses; time management; registration; and transcript forms for nontraditional programs. (LBH)

School Roofing Asset Management

ERIC Educational Resources Information Center

McNeil, Dennis

2011-01-01

Maintenance of physical structures always has been a significant challenge for education institutions, but today's economic climate, which has cut budgets to the bone, has raised the stakes. Funding, staffing and resources for proper maintenance are becoming harder to find, and the need for upkeep and maintenance remains constant. Nowhere is this…

The Intermediary Guidebook: Making and Managing Community Connections for Youth.

ERIC Educational Resources Information Center

Miller, Marc; Kazis, Richard; Trippe, Steve; Eagleson, Glenn; Porter, Lois Ann

This guidebook summarizes learning on the role of intermediaries and how to build organizations that perform intermediary functions effectively and efficiently. An introduction defines intermediaries, in the context of youth-serving systems, as staffed organizations that connect schools and other youth-preparation organizations with workplaces and…

Physical and Emotional Stresses of Technology on Employees in the Workplace

ERIC Educational Resources Information Center

Soylu, Ali; Campbell, Stefanie Snider

2012-01-01

This article presents how today's technology permeates the planning, organizing, staffing, leading, and controlling functions of human resources management. Certain industries or occupations are more reliant on technology and thus impose more physical and emotional stressors on employees. The effects of physical stressors and the physical…

The Strategic Assessment Model.

ERIC Educational Resources Information Center

Glazner, Steve, Ed.

This book presents six papers focusing on the application of the strategic assessment model (SAM) to the management of higher education facilities. The papers are part of an ongoing effort by the Association of Higher Education Facilities Officers to provide comparative cost and staffing information and to develop a benchmarking process. The…

The Pilot Staffing Conundrum: A Delphi Study

DTIC Science & Technology

2009-06-01

Project, AFIT/ GMO /LAL/98J-2. School of Logistics and Acquisition Management, Air Force Institute of Technology (AU), Wright Patterson AFB, OH, June...Kafer, John H. Relationship of Airline Pilot Demand and Air Force Pilot Retention. Graduate Research Project, AFIT/ GMO /LAL/98J-11. School of Logistics

29 CFR 1952.383 - Completion of developmental steps and certification.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., March, 1978. (g) Adopt the Field Operations Manual, April, 1980. (h) Adopt management information system..., February, 1978. (q) Boiler and Elevator Program, June, 1980. (r) Staffing on Board for consultation, laboratory, boiler and elevators, February, 1980. (s) In accordance with § 1902.34 of this chapter, the...

29 CFR 1952.383 - Completion of developmental steps and certification.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., March, 1978. (g) Adopt the Field Operations Manual, April, 1980. (h) Adopt management information system..., February, 1978. (q) Boiler and Elevator Program, June, 1980. (r) Staffing on Board for consultation, laboratory, boiler and elevators, February, 1980. (s) In accordance with § 1902.34 of this chapter, the...

78 FR 68029 - Announcement of Changes to the Membership of the Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

...: Ruthie B. Stewart, U.S. Department of Commerce, Office of Human Resources Management (OHRM), Office of Executive Resources, 14th and Constitution Avenue NW., Room 51010, Washington, DC 20230, at (202) 482-3130..., Office of Staffing, Recruitment and Classification, Department of Commerce Human Resources Operations...

77 FR 64796 - Membership of the Bureau of Industry and Security Performance Review Board

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-23

...: Ruthie B. Stewart, Department of Commerce Human Resources Operations Center (DOCHROC), Office of Staffing... Classification, Department of Commerce Human Resources Operations Center. [FR Doc. 2012-26062 Filed 10-22-12; 8... the appointing authority on other performance management issues, such as pay adjustments, bonuses and...

76 FR 66043 - Membership of the National Telecommunications and Information Administration's Performance Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-25

... Human Resources Operations Center (DOCHROC), Office of Staffing, Recruitment, and Classification..., Career SES. Karl B. Nebbia, Associate Administrator for Spectrum Management, Career SES. Alan W. Vincent... Commerce Human Resources Operations Center. [FR Doc. 2011-27486 Filed 10-24-11; 8:45 am] BILLING CODE 3510...

76 FR 64075 - Membership of the National Telecommunications and Information Administration's Performance Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

... Human Resources Operations Center (DOCHROC), Office of Staffing, Recruitment, and Classification.... Karl B. Nebbia, Associate Administrator for Spectrum Management, Career SES. Alan W. Vincent, Associate... Human Resources Operations Center. [FR Doc. 2011-26736 Filed 10-14-11; 8:45 am] BILLING CODE 3510-25-P ...

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…

A Benchmarking Study of Air Force Program Manager Competencies

DTIC Science & Technology

2012-03-01

New tools and techniques are needed for managing complex projects. • There is an inevitability of scope creep, especially if the project is...workforce could be reshaped. The Task Force identified new initiatives as well as existing DOD programs that were considered innovative approaches to...projected growth of its civilian workforce in order to keep civilian staffing at fiscal 2010 levels (AF News , 2011). One person hired for every two new

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...

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.

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.

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.

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

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

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.,…

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…

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

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.

Library Information Desk. An Organizational and Operating Guide.

ERIC Educational Resources Information Center

Souza, Mary Beth

Intended for those who manage, organize, and oversee the information desk of the State University of New York at Stony Brook Library, this guide contains practical information about staffing, acquiring materials, and operating procedures. The guide opens with a list of suggestions for recruiting and scheduling volunteers for the information desk.…

Staffing for Success: Linking Teacher Evaluation and School Personnel Management in Practice

ERIC Educational Resources Information Center

Master, Benjamin

2014-01-01

Teacher evaluation is at the center of current education policy reform. Most evaluation systems rely at least in part on principals' assessments of teachers, and their discretionary judgments carry substantial weight. However, we know relatively little about what they value when determining evaluations and high stakes personnel decisions.…

Data Administration at a Regional University: A Case Study.

ERIC Educational Resources Information Center

Gose, Frank J.

Data administration (DA) is a position that has emerged with the growth of information technologies. A review of DA literature confirms that, although DA is widely associated with database management systems (DBMS), there is no standard DA job description, DA staffing and location within the organization vary, and DA functions range in description…

The ICCB Computer Based Faculty and Staff Utilization Subsystem.

ERIC Educational Resources Information Center

Lach, Ivan J.

The Illinois Community College Board (ICCB) Faculty and Staff Utilization subsystem, a component of the ICCB management information system, was designed to produce meaningful and useful information reports for the analysis of faculty and staff, as a resource, in Illinois community colleges. Accommodating the complex nature of staffing at the 49…

Economics of Computing: The Case of Centralized Network File Servers.

ERIC Educational Resources Information Center

Solomon, Martin B.

1994-01-01

Discusses computer networking and the cost effectiveness of decentralization, including local area networks. A planned experiment with a centralized approach to the operation and management of file servers at the University of South Carolina is described that hopes to realize cost savings and the avoidance of staffing problems. (Contains four…

Benchmarking Investments in Advancement: Results of the Inaugural CASE Advancement Investment Metrics Study (AIMS). CASE White Paper

ERIC Educational Resources Information Center

Kroll, Juidith A.

2012-01-01

The inaugural Advancement Investment Metrics Study, or AIMS, benchmarked investments and staffing in each of the advancement disciplines (advancement services, alumni relations, communications and marketing, fundraising and advancement management) as well as the return on the investment in fundraising specifically. This white paper reports on the…

77 FR 26278 - Information Collection Being Reviewed by the Federal Communications Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

... post staffed 24 hours a day) in the FCC's Communications and Crisis Management Center in Washington, DC..., provision is made for the submission of required data by other than electronic means in cases where electronic submission is not feasible. In cases where specified offices and facilities (other than 911...

78 FR 12358 - Cardinal Health, Financial Shared Services West, Including On-Site Leased Workers From Aerotek...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-82,253] Cardinal Health, Financial Shared Services West, Including On- Site Leased Workers From Aerotek, eXcel Staffing, Experis Finance (Manpower), Ricoh, USA, Dawson Creative, Mergis Group and Tailored Management, Albuquerque, NM; Amended Certification Regarding Eligibility To...

Development and application of an acceptance testing model

NASA Technical Reports Server (NTRS)

Pendley, Rex D.; Noonan, Caroline H.; Hall, Kenneth R.

1992-01-01

The process of acceptance testing large software systems for NASA has been analyzed, and an empirical planning model of the process constructed. This model gives managers accurate predictions of the staffing needed, the productivity of a test team, and the rate at which the system will pass. Applying the model to a new system shows a high level of agreement between the model and actual performance. The model also gives managers an objective measure of process improvement.

An Analysis of Implementing a Rental Policy within the DoD’s Military Family Housing Program

DTIC Science & Technology

1994-06-01

801 authorizes the government to contract with local businesses for family housing units built to service standards. Under this program the government...housing." [Ref. 4:p.1] DMRD 910 was not approved. 2. DMRD 966: Operating MFH as a Business Enterprise The next DMRD that addressed military family ... business -like manner are: 1. F-using managers would obtain control of their staffing, purchasing and increased contracting authority. Managers could

Do trauma courses change practice? A qualitative review of 20 courses in East, Central and Southern Africa.

PubMed

Ologunde, Rele; Le, Grace; Turner, Jim; Pandit, Hemant; Peter, Noel; Maurer, David; Hodgson, Sam; Larvin, Joseph; Lavy, Chris

2017-09-01

Trauma courses have been shown to improve clinical knowledge and patient outcomes. However, little is known about the individual drivers of change in practice amongst course participants in their home clinic environment. Front-line healthcare workers participated in a two-day Primary Trauma Care (PTC) course. Immediately after the course participants completed an evaluation survey on intended change in the management of trauma patients. Six months after the course, participants completed a survey on actual changes that had occurred. A total of 451 participants were sampled, with 321 responding at 6 months, from 40 courses across East, Central and Southern Africa. The most commonly reported intended change was the adoption of an ABCDE/systematic approach (53%). Six months after the course, 92.7% of respondents reported that they had made changes in their management, with adoption of an ABCDE/systematic approach (50.0%) remaining most common. 77% of participants reported an improvement in departmental trauma management, 26% reported an increase in staffing, 29% an increase in equipment and 68% of participants had gone on to train other healthcare workers in PTC. The findings suggest that PTC courses not only improve individual management of trauma patients but also but is also associated with beneficial effects for participants' host institutions with regards to staffing, equipment and training. Copyright © 2017 Elsevier Ltd. All rights reserved.

KENNEDY SPACE CENTER, FLA. - Key officials are poised to cut the ribbon officially dedicating the new Security gates on Kennedy Parkway (Gate 2) and NASA Parkway (Gate 3). From left are Wally Schroeder, with Jones, Edmunds & Associates; Bobby Porter, with Oneida Construction; Daniel Tweed, NASA project manager; Jim Kennedy, Center director; and William Sample, SGS deputy program manager. The new gates were activated Aug. 1, allowing the general public to have access to the new Space Commerce Way, which will provide access to the Research Park and KSC Visitor Complex, and providing an alternate route for the general public between Titusville and Merritt Island that is accessible 24 hours a day. The gates are staffed 24 hours daily.

NASA Image and Video Library

2003-08-27

KENNEDY SPACE CENTER, FLA. - Key officials are poised to cut the ribbon officially dedicating the new Security gates on Kennedy Parkway (Gate 2) and NASA Parkway (Gate 3). From left are Wally Schroeder, with Jones, Edmunds & Associates; Bobby Porter, with Oneida Construction; Daniel Tweed, NASA project manager; Jim Kennedy, Center director; and William Sample, SGS deputy program manager. The new gates were activated Aug. 1, allowing the general public to have access to the new Space Commerce Way, which will provide access to the Research Park and KSC Visitor Complex, and providing an alternate route for the general public between Titusville and Merritt Island that is accessible 24 hours a day. The gates are staffed 24 hours daily.

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...

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…

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...

EMS-physicians' self reported airway management training and expertise; a descriptive study from the Central Region of Denmark

PubMed Central

2011-01-01

Background Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS). Methods The EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians. Results There are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s), 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management. Conclusions In this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed. PMID:21303510

The influence of organizational factors on patient safety: Examining successful handoffs in health care.

PubMed

Richter, Jason P; McAlearney, Ann Scheck; Pennell, Michael L

2016-01-01

Although patient handoffs have been extensively studied, they continue to be problematic. Studies have shown poor handoffs are associated with increased costs, morbidity, and mortality. No prior research compared perceptions of management and clinical staff regarding handoffs. Our aims were (a) to determine whether perceptions of organizational factors that can influence patient safety are positively associated with perceptions of successful patient handoffs, (b) to identify organizational factors that have the greatest influence on perceptions of successful handoffs, and (c) to determine whether associations between perceptions of these factors and successful handoffs differ for management and clinical staff. A total of 515,637 respondents from 1,052 hospitals completed the Hospital Survey on Patient Safety Culture that assessed perceptions about organizational factors that influence patient safety. Using weighted least squares multiple regression, we tested seven organizational factors as predictors of successful handoffs. We fit three separate models using data collected from (a) all staff, (b) management only, and (c) clinical staff only. We found that perceived teamwork across units was the most significant predictor of perceived successful handoffs. Perceptions of staffing and management support for safety were also significantly associated with perceived successful handoffs for both management and clinical staff. For management respondents, perceptions of organizational learning or continuous improvement had a significant positive association with perceived successful handoffs, whereas the association was negative for clinical staff. Perceived communication openness had a significant association only among clinical staff. Hospitals should prioritize teamwork across units and strive to improve communication across the organization in efforts to improve handoffs. In addition, hospitals should ensure sufficient staffing and management support for patient safety. Different perceptions between management and clinical staff with respect to the importance of organizational learning are noteworthy and merit additional study.

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

PubMed

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

2006-07-01

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

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.

Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies.

PubMed

Vifladt, Anne; Simonsen, Bjoerg O; Lydersen, Stian; Farup, Per G

2016-02-01

Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period. Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured). Intensive care units in hospitals at one Norwegian hospital trust. The safety culture was measured with Hospital Survey on Patient Safety Culture. At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing. In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Attributes of nursing work environment as predictors of registered nurses' job satisfaction and intention to leave.

PubMed

Choi, Sandy Pin-Pin; Cheung, Kin; Pang, Samantha Mei-Che

2013-04-01

To examine how front-line registered nurses' perception of their work environment associates with and predicts nurse outcomes in terms of job satisfaction and turnover intention. Mounting evidence has pointed to an inseparable link between attributes of the nursing work environment and nurse outcomes. However, there is a paucity of research examining nurses' perception of their work environment beyond the Western context. This cross-sectional survey involved 1271 registered nurses working in 135 inpatient units in 10 public hospitals in Hong Kong. The instrument comprised items developed from in-depth interviews with front-line nurses that explored nurses' perception of their work environment. Factor analysis identified five dimensions (professionalism, co-worker relationship, management, staffing and resources, and ward practice) of the nursing work environment. Logistic regression analysis further identified professionalism, management and ward practice as significant factors in predicting nurses' turnover intention, and staffing and resources as an additional factor in predicting their job satisfaction. Attributes of the nursing work environment have a significant bearing on nurses' job satisfaction and intention to leave. Managerial effort should focus on improving nurses' work conditions through detailed resource planning, effective management and removal of work constraints that affect nursing practice. © 2012 Blackwell Publishing Ltd.

Anesthesia Practices for Interventional Radiology in Europe.

PubMed

Vari, Alessandra; Gangi, Afshin

2017-06-01

The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe. Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology. Predictable differences between countries and national regulations were confirmed, showing how significantly many "local" factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care. Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

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

Hospital nurse productivity enhancement.

PubMed

Eastaugh, Steven R

2007-01-01

Nurse staffing patterns have come under increased scrutiny as hospital managers attempt to control costs without harming service quality or staff morale. This study presents production function results from a study of nurse output from 2002 to 2005. The results suggest that productivity varies widely among the 39 hospitals as a function of staffing patterns, methods of organization, and the degree of reliance on nurse extender technicians. Nurse extenders can enhance the marginal value product of the most educated nurses as the RNs concentrate their workday around patient care activities. The results suggest that nurse extenders free RNs from the burden of nonnursing tasks. Incentive pay for nurses based on productivity gains is associated with enhanced productivity. One should get the greatest output for the least input effort, better balancing all factors of service delivery to achieve the most with the smallest resource effort.

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…

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...

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.

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

Medical management of motor fluctuations.

PubMed

Dewey, Richard B

2008-08-01

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

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.

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.

The Journey: "Good Management Begins with Good People"

ERIC Educational Resources Information Center

Vicars, Dennis

2012-01-01

A day in the life of anyone who works in or around a center-based early care and education program is one of numerous duties, timelines, staffing issues, program concerns, parent meetings, training, budget analysis, and teaching. The list is endless. Their days are filled with multiple priorities, all demanding their time and energy. It's so easy…

Center for Collegiate Mental Health (CCMH) 2014 Annual Report. Publication No. STA 15-30

ERIC Educational Resources Information Center

Center for Collegiate Mental Health, 2015

2015-01-01

The mental health of today's college students continues to be a top-level concern for institutions of higher education, whether it is viewed from the perspective of staffing mental health services on campus, responding to after-hours crises in residence halls, providing accessible treatment with limited budgets, managing behavioral threats, or…

Managing Potential Laboratory Exposure to Ebola Virus by Using a Patient Biocontainment Care Unit

DTIC Science & Technology

2008-06-01

which was popularized in the book The Hot Zone (6). The MCS is staffed by USAMRIID personnel, with augmentation and specialized care provided by...ohs/ biosfty/bmbl5/bmbl5toc.htm 2. Bray M, Hatfi ll S, Hensley L, Huggins JW. Haematological , bio- chemical and coagulation changes in mice, guinea

The Alaska experience

NASA Technical Reports Server (NTRS)

Mutter, D. L.

1981-01-01

The management responsibilities of the Alaska Department of Natural Resources are summarized and the establishment of a geoprocessor system is described. Specific capabilities were defined based on surveys of potential users and pre-existing systems. The procurement process, the initially purchased equipment, and system upgrading are described. Cost, installation and maintenance, site location, training, and staffing of the system are examined.

Life in the Cloud: A WorldShare Management Services Case Study

ERIC Educational Resources Information Center

Hartman, Robin R.

2012-01-01

A small, private academic library took the risk of moving from a traditional integrated library system to adopting a system "in the cloud." This case study presents the setting, history, and local needs of the library, including staffing challenges, and explains the decision-making rationale and process. A description of the library's transition…

School Staffing and Performance Management in Newark Public Schools. Executive Summary

ERIC Educational Resources Information Center

New Teacher Project, 2009

2009-01-01

In the winter and spring of 2009, The New Teacher Project (TNTP) partnered with Newark Public Schools (NPS) to investigate the impact of the school district's policies and practices on the ability of schools to build and maintain strong instructional teams. TNTP's analysis of policy and practice in NPS, funded by The Prudential Foundation, reveals…

The Alaska experience

NASA Astrophysics Data System (ADS)

Mutter, D. L.

1981-09-01

The management responsibilities of the Alaska Department of Natural Resources are summarized and the establishment of a geoprocessor system is described. Specific capabilities were defined based on surveys of potential users and pre-existing systems. The procurement process, the initially purchased equipment, and system upgrading are described. Cost, installation and maintenance, site location, training, and staffing of the system are examined.

Improvement in the Quality of Worklife and Productivity: A Joint Venture Between Management and Employees. Final Report.

ERIC Educational Resources Information Center

Glaser, Edward M.; And Others

A 3-year research project conducted at a new pharmaceutical manufacturing plant was designed to determine whether quality of worklife (QWL) consultation provided to a new plant during its planning, staffing, organizing, and initial operation would contribute to improved job satisfaction and productivity as compared with a long-established, more…

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…

No place like home.

PubMed

Benavidez, Teresa; Friedman, Beth

2003-07-01

To ease staffing burdens, Seton Healthcare Network established a home coding program. DNFB claims pending the health information management department's code assignment consistently decreased, reducing the organization's dollars holding by 25 percent. Decreases in contract and as-needed labor contributed to an operational cost savings of about $200,000 per year. The organization was able to fill all of its coding vacancies.

77 FR 46950 - Post Office Organization and Administration: Establishment, Classification, and Discontinuance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-07

... defines a remotely managed Post Office (RMPO) as a Post Office that offers part-time window service hours... Administrative Post Office. The final rule also defines a part-time Post Office (PTPO) as a Post Office that offers part-time window service hours, is staffed by a Postal Service employee, and reports to a district...

77 FR 60166 - Agency Information Collection Activities: Requests for Comments; Clearance of Renewed Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

... Management (OPM) online USAJOBS system and the FAA's Automated Vacancy Information Access Tool for Online Referral (AVIATOR) staffing tool. Type of Review: Renewal of an information collection. Background: Under... Business Services Division, AES-200. [FR Doc. 2012-24190 Filed 10-1-12; 8:45 am] BILLING CODE 4910-13-P ...

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.

Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

PubMed

Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

2013-11-01

Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

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

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.

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.

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

PubMed

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

2011-09-01

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

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.

A Combined Energy Management Algorithm for Wind Turbine/Battery Hybrid System

NASA Astrophysics Data System (ADS)

Altin, Necmi; Eyimaya, Süleyman Emre

2018-03-01

From an energy management standpoint, natural phenomena such as solar irradiation and wind speed are uncontrolled variables, so the correlation between the energy generated by renewable energy sources and energy demand cannot always be predicted. For this reason, energy storage systems are used to provide more efficient renewable energy systems. In these systems, energy management systems are used to control the energy storage system and establish a balance between the generated power and the power demand. In addition, especially in wind turbines, rapidly varying wind speeds cause wind power fluctuations, which threaten the power system stability, especially at high power levels. Energy storage systems are also used to mitigate the power fluctuations and sustain the power system's stability. In these systems, another controller which controls the energy storage system power to mitigate power fluctuations is required. These two controllers are different from each other. In this study, a combined energy management algorithm is proposed which can perform both as an energy control system and a power fluctuation mitigation system. The proposed controller is tested with wind energy conversion system modeled in MATLAB/Simulink. Simulation results show that the proposed controller acts as an energy management system while, at the same time, mitigating power fluctuations.

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.

Planning Staff and Space Capacity Requirements during Wartime.

PubMed

Kepner, Elisa B; Spencer, Rachel

2016-01-01

Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.

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…

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.

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.

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.

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: an interview study

PubMed Central

Tong, Allison; Campbell, Katrina L; Craig, Jonathan C; Lee, Vincent W

2018-01-01

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient–clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis. PMID:29523567

A comparison of three methods for estimating the requirements for medical specialists: the case of otolaryngologists.

PubMed Central

Anderson, G F; Han, K C; Miller, R H; Johns, M E

1997-01-01

OBJECTIVE: To compare three methods of computing the national requirements for otolaryngologists in 1994 and 2010. DATA SOURCES: Three large HMOs, a Delphi panel, the Bureau of Health Professions (BHPr), and published sources. STUDY DESIGN: Three established methods of computing requirements for otolaryngologists were compared: managed care, demand-utilization, and adjusted needs assessment. Under the managed care model, a published method based on reviewing staffing patterns in HMOs was modified to estimate the number of otolaryngologists. We obtained from BHPr estimates of work force projections from their demand model. To estimate the adjusted needs model, we convened a Delphi panel of otolaryngologists using the methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Wide variation in the estimated number of otolaryngologists required occurred across the three methods. Within each model it was possible to alter the requirements for otolaryngologists significantly by changing one or more of the key assumptions. The managed care model has a potential to obtain the most reliable estimates because it reflects actual staffing patterns in institutions that are attempting to use physicians efficiently. CONCLUSIONS: Estimates of work force requirements can vary considerably if one or more assumptions are changed. In order for the managed care approach to be useful for actual decision making concerning the appropriate number of otolaryngologists required, additional research on the methodology used to extrapolate the results to the general population is necessary. PMID:9180613

Nurse staffing and NICU infection rates.

PubMed

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

2013-05-01

There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. Hospitals understaffed 31% of their NICU infants and 68% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.34 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.4% in 2008 and 13.9% in 2009. A 1 standard deviation-higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.40 (95% CI, 1.19-1.65; P < .001) in 2009. Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants.

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

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.

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.

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.

Designing a podiatry service to meet the needs of the population: a service simulation.

PubMed

Campbell, Jackie A

2007-02-01

A model of a podiatry service has been developed which takes into consideration the effect of changing access criteria, skill mix and staffing levels (among others) given fixed local staffing budgets and the foot-health characteristics of the local community. A spreadsheet-based deterministic model was chosen to allow maximum transparency of programming. This work models a podiatry service in England, but could be adapted for other settings and, with some modification, for other community-based services. This model enables individual services to see the effect on outcome parameters such as number of patients treated, number discharged and size of waiting lists of various service configurations, given their individual local data profile. The process of designing the model has also had spin-off benefits for the participants in making explicit many of the implicit rules used in managing their services.

Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study.

PubMed

Berg Jansson, Anna; Engström, Åsa

2017-08-01

The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

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.

Developing a strategic plan for a neonatal nurse practitioner service.

PubMed

Lee, Laurie A; Jones, Luann R

2004-10-01

Neonatal nurse practitioners (NNPs) have been in practice for over 3 decades. More recently, NNPs have begun to take ownership for building their group practice models. The purpose of this article is to present a detailed case study demonstrating how one NNP group used a 4-phase strategic planning process to turn a crisis into an opportunity. The article describes data obtained during the strategic planning process from an informal national survey of NNP managers that focused on key benchmarks, such as role definition, responsibilities, protected nonclinical time, NNP salary and benefits, and educational and professional development support. Using the strategic planning process, the group defined mutually agreed upon minimum safe staffing levels for NNPs, interns, residents and neonatologists in their setting. Based on the data generated, the group successfully justified additional NNP positions and organizational support for 10% protected nonclinical time. A sample operational budget, comparison of 3 staffing scenarios, and a timeline are also provided.

Does a full-time, 24-hour intensivist improve care and efficiency?

PubMed

Carlson, R W; Weiland, D E; Srivathsan, K

1996-07-01

This article reviews the hypothesis that staffing with full-time intensive care physicians leads to improvements in the management of ICUs and in the outcome for ICU patients. Variations in the professional organization of critical care units in the United States are discussed. The advantages and disadvantages of open, closed, and transitional (comanagement) ICU organizational structures are presented.

Remote sensing procurement package: A management report for state and local governments

NASA Technical Reports Server (NTRS)

1981-01-01

An overview of the remote sensing procurement process is presented for chief executives, senior administrators, and other local and state officials responsible for purchasing remote sensing products, services, or equipment. Guidelines are provided for planning, organizing, staffing, and implementing such a procurement project. Other sections of the four-volume package are described and their benefits examined.

The National Shipbuilding Research Program. 1985 Ship Production Symposium. Volume 1, Paper No. 13: Engineering Management for Zone Construction of Ships.

DTIC Science & Technology

1985-09-01

steadily developed along with the better understanding of human relations, moti- vation and worklife sciences. That this is so, is clear from a review of...accomplish its goals effectively and efficiently if it is not staffed with the correct number of people with the correct balance of education, training and

A Baseline Description of DTIC Scientific and Technical Information Support System

DTIC Science & Technology

1986-09-01

discussed below. Operations Research And Economic Analysis Office (DTIC-LO) This organizational element is currently being staffed. Its primary planned... Analysis Centers DASIAC - Ed Martin, Dave Reitz GACIAC - Richard Bartl* MCIAC - Helen Pestel * MMIAC - Sarah Ellingsworth...Overall Organization 2-5 Office Of The Administrator And Personal Staff 2-7 Equal Employment Opportunity Manager 2-7 Information Analysis

Domestic Non-Resident Undergraduate Enrollment in Public Research Universities: The Influence of Institutional and Regional Factors

ERIC Educational Resources Information Center

Goodale, Brian D.

2013-01-01

Senior managers in public research universities monitor and anticipate the evolution of enrollment as part of a planning process that is linked to budget and staffing matters. While the tracking and planning of enrollment figures is important for all types of institutions, the position of public research universities and the non-resident students…

Changes in the Hiring Process: New Actors, New Practices, and New Challenges. Final Report. Volume I: Findings and Implications [and] Volume II: Appendices.

ERIC Educational Resources Information Center

Kogan, Deborah; And Others

Trends in the recruitment and hiring practices of U.S. private sector firms were examined by analyzing data from the following: a literature review; telephone discussions with representatives of 13 key national labor market intermediaries (outplacement, career management, job search, screening, and staffing service firms); telephone discussions…

X Marks the Spot: Creating and Managing a Single Service Point to Improve Customer Service and Maximize Resources

ERIC Educational Resources Information Center

Venner, Mary Ann; Keshmiripour, Seti

2016-01-01

This article will describe how merging service points in an academic library is an opportunity to improve customer service and utilize staffing resources more efficiently. Combining service points provides libraries with the ability to create a more positive library experience for patrons by minimizing the ping-pong effect for assistance. The…

Results of a Survey Software Development Project Management in the U.S. Aerospace Industry. Volume III. Major Problems.

DTIC Science & Technology

1979-12-18

simplifies the staffing of a project and assures the experience is ’ recyclable ’." "Staff or members are considered ’universal experts’. During estimation...impact of changes upon the original system." "Project reviews are typically exercises in trivia ." [Keider, 1974] ____ ,,, , _ 55 "First, [lesson

Staffing Policies and Strategies; American Society for Personnel Administration Handbook of Personnel and Industrial Relations, Volume 1.

ERIC Educational Resources Information Center

Yoder, Dale, Ed.; Heneman, Herbert G., Jr., Ed.

Aimed at providing a broader understanding and appreciation of the mission and contributions of personnel management, the first volume of the seven volume handbook is authored by experts from industry, the public service, and the academic community. It is intended for both practitioners and students preparing for careers in personnel and…

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.

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 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.

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

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.

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.

Anesthesia Practices for Interventional Radiology in Europe

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

Vari, Alessandra, E-mail: alessandra.vari@uniroma1.it; Gangi, Afshin, E-mail: gangi@unistra.fr

PurposeThe Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.MethodsAnonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.ResultsPredictable differences betweenmore » countries and national regulations were confirmed, showing how significantly many “local” factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.ConclusionSignificant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.« less

The effects of managed care and prospective payment on the demand for hospital nurses: evidence from California.

PubMed

Spetz, J

1999-12-01

To examine the effects of managed care and the prospective payment system on the hospital employment of registered nurses (RNs), licensed practical nurses (LPNs), and aides. Hospital-level data from California's Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Reports from 1976/1977 through 1994/1995. Additional information is extracted from OSHPD Patient Discharge Data. Multivariate regression equations are used to estimate demand for nurses as a function of wages, hospital output, technology level, and ownership. Separate equations are estimated for RNs, LPNs, and aides for all daily services and for medical-surgical units. Instrumental variables are used to correct for the endogeneity of wages, and fixed effects are included to control for unobserved differences across hospitals. HMOs are associated with a lower use of LPNs and aides, and HMOs do not have a statistically significant effect on the demand for RNs. Managed care has a smaller effect on nurse staffing in medical-surgical units than in daily service units as a whole. The prospective payment system does not have a statistically significant effect on nurse staffing. HMOs have affected nursing employment both because HMOs have reduced the number of discharges and because of a direct relationship between HMO penetration and the demand for LPNs and aides. Contrary to press reports, LPNs and aides have been affected more by HMOs than have registered nurses.

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%).

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...

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.

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.

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

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

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.

Value-Based Emergency Management.

PubMed

Corrigan, Zachary; Winslow, Walter; Miramonti, Charlie; Stephens, Tim

2016-02-01

This article touches on the complex and decentralized network that is the US health care system and how important it is to include emergency management in this network. By aligning the overarching incentives of opposing health care organizations, emergency management can become resilient to up-and-coming changes in reimbursement, staffing, and network ownership. Coalitions must grasp the opportunity created by changes in value-based purchasing and impending Centers for Medicare and Medicaid Services emergency management rules to engage payers, physicians, and executives. Hope and faith in doing good is no longer enough for preparedness and health care coalitions; understanding how physicians are employed and health care is delivered and paid for is now necessary. Incentivizing preparedness through value-based compensation systems will become the new standard for emergency management.

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.

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.

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.

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

PubMed

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

2014-09-01

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

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...

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…

Implications of online learning for nurse managers.

PubMed

McCarthy, Jillian

2014-10-30

Online learning for nurses is growing in popularity, with programmes ranging from mandatory update training to part-time master's degrees. E-learning, as it is known, offers flexibility in access to learning, study time and learning styles. In busy clinical areas, where guidance is provided on minimum nurse staffing levels, e-learning provides solutions for managers who wish to encourage professional development while maintaining adequate nursing cover. Caution must be taken, however, when choosing e-learning programmes, as quality and efficacy differ across the range. This article highlights the properties of good e-learning pedagogy to prepare nurse managers for successful assessment of these programmes.

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.

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

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.

[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.

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.

Nursing intellectual capital theory: operationalization and empirical validation of concepts.

PubMed

Covell, Christine L; Sidani, Souraya

2013-08-01

To present the operationalization of concepts in the nursing intellectual capital theory and the results of a methodological study aimed at empirically validating the concepts. The nursing intellectual capital theory proposes that the stocks of nursing knowledge in an organization are embedded in two concepts, nursing human capital and nursing structural capital. The theory also proposes that two concepts in the work environment, nurse staffing and employer support for nursing continuing professional development, influence nursing human capital. A cross-sectional design. A systematic three-step process was used to operationalize the concepts of the theory. In 2008, data were collected for 147 inpatient units from administrative departments and unit managers in 6 Canadian hospitals. Exploratory factor analyses were conducted to determine if the indicator variables accurately reflect their respective concepts. The proposed indicator variables collectively measured the nurse staffing concept. Three indicators were retained to construct nursing human capital: clinical expertise and experience concept. The nursing structural capital and employer support for nursing continuing professional development concepts were not validated empirically. The nurse staffing and the nursing human capital: clinical expertise and experience concepts will be brought forward for further model testing. Refinement for some of the indicator variables of the concepts is indicated. Additional research is required with different sources of data to confirm the findings. © 2012 Blackwell Publishing Ltd.

Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review.

PubMed

Dawson, A J; Nkowane, A M; Whelan, A

2015-12-18

Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between nurses and midwives and other health providers and organizations, across sectors, and with communities and individuals that resulted in improved health care and outcomes. The findings of this review confirm the importance of a conceptual framework for understanding and planning leadership and governance approaches, management strategies and collaboration and education and training efforts to scale up and support nurses and midwives in existing or expanded roles to improve access to PHC for vulnerable populations.

Command History for 1988

DTIC Science & Technology

1989-02-01

installs, and provides life cycle support for information management systems. 16. Provides information and reports to higher authority and the scientific com...instruction/policy. 29 November New Employees Margaret Overton Paula Augustine Staffing Clerk Clerk Typist Code OOB Code I I GS-203-4 GS-322-4 Sylvia ...Evaluation and Survey Systems-Develops systems to evaluate the effectiveness of quality of life programs and to improve the quality of personnel

Statewide Police Command and Supervisory Training -- Three Demonstration Projects: New Jersey Mobile Training Units; North Carolina Police Management Institute; Arkansas Regional Courses for Police Supervisors.

ERIC Educational Resources Information Center

New Jersey Police Training Commission, Trenton.

Three police training programs varied markedly and present a selection of models appropriate to different circumstances and training needs. The New Jersey Police Training Commission provides for supervisory training through the use of mobile classrooms staffed with trained professional teams, equipped with modern teaching aids, and experimenting…

Building Villages To Raise Our Children: Staffing. Guides to Comprehensive Family Support Services.

ERIC Educational Resources Information Center

Hochberg, Mona R.

This volume, part five of a six-part report, is a three-part guide that offers practical advice for recruiting, training, and managing staff for a family-support program; it includes discussions about typical problems and the ways practitioners have chosen to resolve them. Part 1 discusses how to determine the type of staff needed and how to hire…

An Examination of the Career, Salary and Training Expectations of Information Technology Professionals Working in the Help Desk Field

ERIC Educational Resources Information Center

Flynn, William C.

2013-01-01

The Information Technology (IT) help desk positions serve as the gateway between the IT department and users. Although IT is one of the most employable job categories, and crucial for business, staffing these positions with properly trained and certified IT personnel and retaining them is a major challenge for IT help desk managers. What are the…

The Making of the "Precarious" Examining Indian Immigrant IT Workers in Canada and Their Transnational Networks with Body Shops in India

ERIC Educational Resources Information Center

Maitra, Srabani

2015-01-01

Since the 1990s, temporary staffing agencies have been playing a key role in managing and supplying a ready pool of skilled workers to the global IT market. Yet, such agencies often regulate their workforce to maintain flexible, low-cost and accommodating workers. Due to continuing racial and gendered barriers, many immigrant Indian IT…

DoD Resource Augmentation for Civilian Consequence Management (DRACCM) Tool

DTIC Science & Technology

2015-07-01

staffing availabilities for the nine regions. Finally, we added options to view IDAC data that had included school closings, vaccinations , antivirals...there is enough critical medical resource at that hospital for a given day. An hospital icon coded yellow means that at least one critical medical...tularemia, Q fever , SEB, anthrax, plague (with contagion), VEE, botulism, brucellosis, glanders, smallpox (with contagion), influenza, cesium, sarin, VX

Management of Resources. Proceedings of the Annual Conference of the British Educational Administration Society. (2nd, Edinburg, Scotland, November 10, 1973).

ERIC Educational Resources Information Center

Ewan, E. A., Ed.

This publication contains four conference addresses, responses to those addresses, and a synopsis of eight discussion group reports. The report begins with a paper on staff resources in secondary schools, then considers the problem of assessing the staffing needs of secondary schools and ensuring an adequate supply of qualified secondary teachers,…

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

PubMed

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

2016-08-01

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

Patients' functioning as predictor of nursing workload in acute hospital units providing rehabilitation care: a multi-centre cohort study

PubMed Central

2010-01-01

Background Management decisions regarding quality and quantity of nurse staffing have important consequences for hospital budgets. Furthermore, these management decisions must address the nursing care requirements of the particular patients within an organizational unit. In order to determine optimal nurse staffing needs, the extent of nursing workload must first be known. Nursing workload is largely a function of the composite of the patients' individual health status, particularly with respect to functioning status, individual need for nursing care, and severity of symptoms. The International Classification of Functioning, Disability and Health (ICF) and the derived subsets, the so-called ICF Core Sets, are a standardized approach to describe patients' functioning status. The objectives of this study were to (1) examine the association between patients' functioning, as encoded by categories of the Acute ICF Core Sets, and nursing workload in patients in the acute care situation, (2) compare the variance in nursing workload explained by the ICF Core Set categories and with the Barthel Index, and (3) validate the Acute ICF Core Sets by their ability to predict nursing workload. Methods Patients' functioning at admission was assessed using the respective Acute ICF Core Set and the Barthel Index, whereas nursing workload data was collected using an established instrument. Associations between dependent and independent variables were modelled using linear regression. Variable selection was carried out using penalized regression. Results In patients with neurological and cardiopulmonary conditions, selected ICF categories and the Barthel Index Score explained the same variance in nursing workload (44% in neurological conditions, 35% in cardiopulmonary conditions), whereas ICF was slightly superior to Barthel Index Score for musculoskeletal conditions (20% versus 16%). Conclusions A substantial fraction of the variance in nursing workload in patients with rehabilitation needs in the acute hospital could be predicted by selected categories of the Acute ICF Core Sets, or by the Barthel Index score. Incorporating ICF Core Set-based data in nursing management decisions, particularly staffing decisions, may be beneficial. PMID:21034438

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.

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

Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives.

PubMed

Buckley, Thomas A; Burdette, Glenn; Kelly, Kassandra

2015-08-01

The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited. To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers. Cross-sectional study. Web-based questionnaire. A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions. The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination. Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%, n = 473; Division III = 76.0%, n = 467) and determination of recovery (Division II = 65.0%, n = 194; Division III = 63.1%, n = 288) but not at baseline (Division II = 43.1%, n = 122; Division III = 41.0%, n = 176). Typically, when a postconcussion assessment was initiated, testing occurred daily until baseline values were achieved, and most respondents (80.6% [244/278]) reported using a graded exercise protocol before return to participation. We found limited use of the multifaceted assessment battery at baseline but higher rates at both acute assessment and return-to-participation time points. A primary reason cited for not using test-battery components was a lack of staffing or funding for the assessments. We observed limited use of neuropsychologists to interpret neuropsychological testing. Otherwise, most respondents reported concussion-management protocols consistent with recommendations, including a high level of use of objective measures and incorporation of a progressive return-to-participation protocol.

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…

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…

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…

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…

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...

Adapting risk management and computational intelligence network optimization techniques to improve traffic throughput and tail risk analysis.

DOT National Transportation Integrated Search

2014-04-01

Risk management techniques are used to analyze fluctuations in uncontrollable variables and keep those fluctuations from impeding : the core function of a system or business. Examples of this are making sure that volatility in copper and aluminum pri...

Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

PubMed

Yip, Kenneth; Pang, Suk-King; Chan, Kui-Tim; Chan, Chi-Kuen; Lee, Tsz-Leung

2016-08-08

Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service.

KENNEDY SPACE CENTER, FLA. - Daniel L. Tweed, with the Facilities Division, NASA Spaceport Services, addresses attendees at the ribbon cutting for the KSC Security gates. Tweed was project manager. The two new Security gates on Kennedy Parkway (Gate 2) and NASA Parkway (Gate 3) were activated Aug. 1, allowing the general public to have access to the new Space Commerce Way, which will provide access to the Research Park and KSC Visitor Complex, and providing an alternate route for the general public between Titusville and Merritt Island that is accessible 24 hours a day. The gates are staffed 24 hours daily. Others taking part in the ribbon cutting were Center Director Jim Kennedy; Chief, Protective & Safe Guards Office, Calvin L. Burch; SGS Deputy Program Manager William A. Sample; and Bobby Porter, with Oneida Construction.

NASA Image and Video Library

2003-08-27

KENNEDY SPACE CENTER, FLA. - Daniel L. Tweed, with the Facilities Division, NASA Spaceport Services, addresses attendees at the ribbon cutting for the KSC Security gates. Tweed was project manager. The two new Security gates on Kennedy Parkway (Gate 2) and NASA Parkway (Gate 3) were activated Aug. 1, allowing the general public to have access to the new Space Commerce Way, which will provide access to the Research Park and KSC Visitor Complex, and providing an alternate route for the general public between Titusville and Merritt Island that is accessible 24 hours a day. The gates are staffed 24 hours daily. Others taking part in the ribbon cutting were Center Director Jim Kennedy; Chief, Protective & Safe Guards Office, Calvin L. Burch; SGS Deputy Program Manager William A. Sample; and Bobby Porter, with Oneida Construction.

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

PubMed

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

2016-11-01

A large and increasing number of studies have reported a relationship between low nurse staffing levels and adverse outcomes, including higher mortality rates. Despite the evidence being extensive in size, and having been sometimes described as "compelling" and "overwhelming", there are limitations that existing studies have not yet been able to address. One result of these weaknesses can be observed in the guidelines on safe staffing in acute hospital wards issued by the influential body that sets standards for the National Health Service in England, the National Institute for Health and Care Excellence, which concluded there is insufficient good quality evidence available to fully inform practice. In this paper we explore this apparent contradiction. After summarising the evidence review that informed the National Institute for Health and Care Excellence guideline on safe staffing and related evidence, we move on to discussing the complex challenges that arise when attempting to apply this evidence to practice. Among these, we introduce the concept of endogeneity, a form of bias in the estimation of causal effects. Although current evidence is broadly consistent with a cause and effect relationship, endogeneity means that estimates of the size of effect, essential for building an economic case, may be biased and in some cases qualitatively wrong. We expand on three limitations that are likely to lead to endogeneity in many previous studies: omitted variables, which refers to the absence of control for variables such as medical staffing and patient case mix; simultaneity, which occurs when the outcome can influence the level of staffing just as staffing influences outcome; and common-method variance, which may be present when both outcomes and staffing levels variables are derived from the same survey. Thus while current evidence is important and has influenced policy because it illustrates the potential risks and benefits associated with changes in nurse staffing, it may not provide operational solutions. We conclude by posing a series of questions about design and methods for future researchers who intend to further explore this complex relationship between nurse staffing levels and outcomes. These questions are intended to reflect on the potential added value of new research given what is already known, and to encourage those conducting research to take opportunities to produce research that fills gaps in the existing knowledge for practice. By doing this we hope that future studies can better quantify both the benefits and costs of changes in nurse staffing levels and, therefore, serve as a more useful tool for those delivering services. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

Baernholdt, M; Lang, N M

2007-03-01

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

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

Turning on the care coordination switch in rural primary care: voices from the practices--clinician champions, clinician partners, administrators, and nurse care managers.

PubMed

Fagnan, Lyle J; Dorr, David A; Davis, Melinda; McGinnis, Paul; Mahler, Jo; King, Molly McCarthy; Michaels, LeAnn

2011-01-01

This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semistructured interviews with 4 staff cohorts. Cohorts included clinician champions, clinician partners, practice administrators, and nurse care managers. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied and additional study is required to determine sustainability.

Using Decision Structures for Policy Analysis in Software Product-line Evolution - A Case Study

NASA Astrophysics Data System (ADS)

Sarang, Nita; Sanglikar, Mukund A.

Project management decisions are the primary basis for project success (or failure). Mostly, such decisions are based on an intuitive understanding of the underlying software engineering and management process and have a likelihood of being misjudged. Our problem domain is product-line evolution. We model the dynamics of the process by incorporating feedback loops appropriate to two decision structures: staffing policy, and the forces of growth associated with long-term software evolution. The model is executable and supports project managers to assess the long-term effects of possible actions. Our work also corroborates results from earlier studies of E-type systems, in particular the FEAST project and the rules for software evolution, planning and management.

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…

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…

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…

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...

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).

Managed care and the delivery of primary care to the elderly and the chronically ill.

PubMed Central

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-01-01

OBJECTIVE: To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. DATA SOURCES/STUDY SETTING: Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. STUDY DESIGN: For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. PRINCIPAL FINDINGS: The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access to PCPs is better in MCOs. But access to specialists and hospitals is lower and more difficult in MCOs than FFS. Data do not suggest that processes of care, given access, are different in MCOs and FFS. MCO enrollees are more satisfied with financial aspects of a health plan and less satisfied with other aspects of health plan organization. There are potential problems with outcomes, with some studies finding greater declines among the chronically ill in MCOs than FFS. We found a variety of innovative care programs for the elderly, based on two fundamentally different approaches: organization around primary care or organizing around specialty care. Differences between the performance of the two approaches cannot be evaluated because of the small amount of research done. It is difficult to say how well particular programs perform and if they can be replicated. The innovative programs described in the literature tend to be benchmark programs developed by HMOs with a strong positive reputation. PMID:9618674

Managed care and the delivery of primary care to the elderly and the chronically ill.

PubMed

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-06-01

To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access to PCPs is better in MCOs. But access to specialists and hospitals is lower and more difficult in MCOs than FFS. Data do not suggest that processes of care, given access, are different in MCOs and FFS. MCO enrollees are more satisfied with financial aspects of a health plan and less satisfied with other aspects of health plan organization. There are potential problems with outcomes, with some studies finding greater declines among the chronically ill in MCOs than FFS. We found a variety of innovative care programs for the elderly, based on two fundamentally different approaches: organization around primary care or organizing around specialty care. Differences between the performance of the two approaches cannot be evaluated because of the small amount of research done. It is difficult to say how well particular programs perform and if they can be replicated. The innovative programs described in the literature tend to be benchmark programs developed by HMOs with a strong positive reputation.

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.

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

Professional development needs of nurse managers.

PubMed

Miltner, Rebecca S; Jukkala, Angela; Dawson, Martha A; Patrician, Patricia A

2015-06-01

Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role. Copyright 2015, SLACK Incorporated.

Staffing for Cyberspace Operations: Summary of Analysis

DTIC Science & Technology

2016-08-01

Planning & Requirements, Office of the Assistant Secretary of Defense for Manpower & Reserve Affairs, Office of the Under Secretary of Defense for...planning effort. Total force mix has long been an important area in defense manpower management, given that the wrong total force mix can put the...mission at risk or result in inefficiencies that consume scarce defense resources. In the cyber arena, the problem is complicated by a lack of legal

A Study of Civilian Registered Nurse Recruitment at Madigan Army Medical Center, Tacoma, Washington.

DTIC Science & Technology

1982-06-01

Marketing Management. Boston: Allyn and Bacon, Inc., 1980. Kotler , Philip . Marketing for Nonprofit Institutions. Englewood Cliffs, N.D.: Prentice-Hall...Interview with Ms. R. Marsh, Staffing Specialist, Force Develop- ment Division, Madigan Army Medical Center, Tacoma, WA (Dec 81) 20Philip Kotler ...Health Care Marketing: Issues and Trends, ed.: Philip D. Cooper (Germantown, MD.: Aspen Systems Corporation, 1979), p. 7. 22 Initial Report, National

Primary care practice organization influences colorectal cancer screening performance.

PubMed

Yano, Elizabeth M; Soban, Lynn M; Parkerton, Patricia H; Etzioni, David A

2007-06-01

To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors. Primary care director survey (1999-2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001). Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery (p<.04), more clinical support arrangements (p<.03), and smaller size (p<.001). Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.

Evaluating the effect of the new incentive system for high-risk pressure ulcer patients on wound healing and cost-effectiveness: a cohort study.

PubMed

Sanada, Hiromi; Nakagami, Gojiro; Mizokami, Yuko; Minami, Yukiko; Yamamoto, Aya; Oe, Makoto; Kaitani, Toshiko; Iizaka, Shinji

2010-03-01

To evaluate the effectiveness and cost-effectiveness of new incentive system for pressure ulcer management, which focused on skilled nurse staffing in terms of rate of healing and medical costs. A prospective cohort study included two types of groups: 39 institutions, which introduced the new incentive system, and 20 non-introduced groups (control). Sixty-seven patients suffering from severe pressure ulcers in the introduced group and 38 patients in the non-introduced group were included. Wound healing and medical costs were monitored weekly for three weeks by their skilled nurses in charge. Healing status and related medical costs. The introduced group showed significantly higher rate of healing compared with the control group at each weekly assessment. Multiple regression analysis revealed that the introduction of the new incentive system was independently associated with the faster healing rate (beta=3.44, P<.001). The budget impact analysis demonstrated that introducing this system could reduce cost of treating severe pressure ulcers by 1.776 billion yen per year. The new incentive system for the management of pressure ulcers, which focused on staffing with skilled nurses can improve healing rate with reduced medical cost. Copyright 2009 Elsevier Ltd. All rights reserved.