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Sample records for managing fluctuating staffing

  1. Benefits of Qualitative Simulation for Managing Fluctuating Staffing Needs

    SciTech Connect

    Nichols, Todd Travis

    2001-07-01

    Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of "soft" variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: 1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times "soft" variables, such as morale, productivity, and efficiency are the sources of such influences; and 2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.

  2. Benefits of Qualitative Simulation for Managing Fluctuating Staffing Needs

    SciTech Connect

    T. T. Nichols

    2001-07-02

    Management of the High Level Waste Program Office at the Idaho National Environmental and Engineering Laboratory has projected oscillating future employment levels. A simple computer model was created to help convince management that qualitative modeling of ''soft'' variables can provide appreciable insight into the consequences and performance of alternative staffing policies. Advocacy of the model underlying the simulation or a particular strategy did not motivate the study, but rather a desire to instill enthusiasm and elicit new and improved conceptual models from management. Six qualitative and three quantitative generic insights to managing staffing levels are gained from the simulations. These insights in their generic form should be familiar to those knowledgeable of system dynamics or computer/instrument process control. Their potential usefulness to developing staffing strategies is stressed. The two primary overarching assertions that flow from the simulation results are: (1) the presence of multiple feedbacks, time delays, and continuous flows introduce instability into a personnel system that complicates the management of staffing levels. Many times ''soft'' variables, such as morale, productivity, and efficiency are the sources of such influences; and (2) such influences can be successfully modeled. In the case of the simple model used in these simulations, for example, the qualitative impact of a strategy using hiring and laying off as the sole managerial interventions is assessed.

  3. Applying Management Information Systems to Staffing.

    ERIC Educational Resources Information Center

    Hanson, Robert L.

    1982-01-01

    After reviewing some concepts and principles for effective data management, the author applies the concepts to nurse staffing systems for the management of human resources. He defines a seven-step process for establishing a management information system, from defining the management objective to implementing the system. (Author/CT)

  4. Determining hospital risk management staffing through analytics.

    PubMed

    Howard, Chrystina M; Felton, Kenneth W

    2013-01-01

    This article presents the development of an independent research project to gather time data from hospital risk managers in order to establish an objective, justifiable means of determining staffing levels recommended to support risk management activities and department functions. © 2013 American Society for Healthcare Risk Management of the American Hospital Association.

  5. Forecasting Staffing Requirements for a Fluctuating Medical Beneficiary Population

    DTIC Science & Technology

    2005-01-12

    care faces many of the same challenges as our national health care system ( Sculley , 2001). A unique aspect of the military medical system is that it...calculated with more accuracy using a’ modified the ASAM during periods of workload variation. This modified version, developed jointly by Mr. John ...Reiser, John . Headquarters, Army Medical Command (MEDCOM), Program Analysis & Evaluation Manpower Requirements Branch (1997). Automated Staffing

  6. National Training for a New Nurse Staffing Resource Management Methodology.

    ERIC Educational Resources Information Center

    Williams, Margaret M.; Blazey, Mary E.

    1998-01-01

    To implement a new resource-management methodology for determining nurse staffing based on expert opinion, a national education program was designed and used to train 172 health care facility coordinators using a systems approach. (SK)

  7. Reconciling Flexible Staffing Models with Inclusive Governance and Management

    ERIC Educational Resources Information Center

    Whitchurch, Celia; Gordon, George

    2013-01-01

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

  8. Managing Decline and Staffing Standards for Quality.

    ERIC Educational Resources Information Center

    Costanzo, Matthew W.

    School boards, administrators, and representatives of the community should develop long-range plans that not only consider the present state of schools but attempt to project 10 years hence. Demographic changes in communities indicate that managing decline will require a willingness to pare expenditures and an attempt to win back citizens'…

  9. Costs and risks of weekend anesthesia staffing at 6 independently managed surgical suites.

    PubMed

    Dexter, Franklin; Epstein, Richard H; Marsh, H Michael

    2002-10-01

    We previously developed a statistical method that managers can use to assure that nurse anesthetists are on call on weekends for as few hours as possible while providing a specified level of care for operating room (OR) patients. The statistically derived staffing solutions are optimal, meaning that the total number of staffed hours is guaranteed to be as low as possible to achieve the specified risk of being unable to care for patients as promptly as they had in the recent past. We used the statistical method to review nurse anesthetist weekend staffing at 6 surgical suites that were part of a healthcare system with a cost-conscious management team. Four of the suites had already made staffing changes resulting in a greater than 6% risk of being understaffed. One suite had adequate current staffing but slightly exceeded the minimum total staffing hours. One suite had more anesthetist coverage than was needed, resulting in excess staffing costs greater than $200,000 per year. We conclude that the principal value of the statistical method may be in helping healthcare system administrators and anesthetists quantify the impact of contemplated reductions in staffing on their risk of understaffing and prologing patients' wait for OR care.

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

    PubMed

    Mobley, Lee R; Magnussen, Jon

    2002-01-01

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

  11. 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.

  12. A statistical analysis of weekday operating room anesthesia group staffing costs at nine independently managed surgical suites.

    PubMed

    Dexter, F; Epstein, R H; Marsh, H M

    2001-06-01

    At many surgical suites, surgeons and patients schedule elective cases on whatever future workday they choose, resulting in there being no limit on the number of cases performed each day. Staff are then scheduled in the manner that satisfies the marketing guarantee to the surgeons, satisfies labor contracts, and minimizes staffing costs. We assessed weekday nurse anesthesia group staffing at nine such suites to determine whether statistical methods can identify staffing solutions whereby all the cases are covered but for which staffing costs are less than those obtained using the staffing plans implemented by anesthesia groups' managers. Two years of operating room information system case duration and staffing data were analyzed. First- and second-shift staffing was assessed using previously published algorithms. The statistical methods identified staffing solutions with significantly decreased labor costs than those currently being used at eight of the nine surgical suites. The statistical methods relied more on overtime than second-shift staffing. The incremental decrease in staffing costs achievable by using overlapping 8-, 10-, and 13-h shifts was negligible. Overall, we found that statistical methods can identify, for some surgical suites, staffing solutions whereby all the cases are covered but for which costs are significantly less and productivity significantly more than those obtained using the plans developed by the managers based on their experience and the data. Statistical methods can identify, for some surgical suites, anesthesia staffing solutions whereby all the cases are covered but for which labor costs are significantly less than those obtained using the staffing plans developed by the managers based on data and their experience.

  13. The Dual Nature of Staffing in the Education Library: Management Issues and Solutions

    ERIC Educational Resources Information Center

    Osa, Justina O.

    2003-01-01

    The dual nature of staffing in the education library, just as in most academic libraries, often constitutes a major source of management problems. The blurring and shifting of tasks for professionals and paraprofessionals, and budgetary constraints do not help the situation. Professionals and paraprofessionals must work in concert and in harmony,…

  14. Staffing Ideas.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1987

    1987-01-01

    Presents business organization and child care center managers with ideas on how to deal with various staffing situations. Ideas include suggestions for handling informal staff networks; getting insight into what is important to people; motivating people in difficult situations; developing temporary employee services for child caregivers; and…

  15. Staffing Ideas.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1987

    1987-01-01

    Presents business organization and child care center managers with ideas on how to deal with various staffing situations. Ideas include suggestions for handling informal staff networks; getting insight into what is important to people; motivating people in difficult situations; developing temporary employee services for child caregivers; and…

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. Intensive care unit nurse managers' views regarding nurse staffing in their units in South Africa.

    PubMed

    Matlakala, Mokgadi C; Botha, Annali D H

    2016-02-01

    To explore the views of the intensive care unit (ICU) nurse managers regarding nurse staffing in the large ICUs. A qualitative design was used to explore the views of the ICU managers. Four individual interviews were conducted with ICU managers. The interviews were audio recorded; transcribed verbatim and content data analysis was undertaken. The settings were ICUs of four private hospitals in the Tshwane metropolitan area in Gauteng Province, South Africa. Two themes that emerged from the data were shortage of competent and trained nurses and problems with agency nurses. Shortage of competent and trained nurses was associated with the global shortage of nurses; and led to increased patient-to-nurse ratios and the use of other categories of nurses, other than professional nurses. The problems with agency nurses were lack of ICU experience and lack of commitment to their professional work. These brought about risks in the provision of quality nursing care. Adequate numbers of competent and committed nurses is essential for efficient patient care and favourable outcomes in the ICUs. The findings demonstrate the importance of provision of ICU trained nurses for patient care, rather than nurse staffing simply to balance the numbers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. 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.

  2. 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

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

    PubMed

    Jooste, Karien; Prinsloo, Carine

    2013-03-13

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

  4. Management Staffing and Training Development Policies in Selected Multinational Enterprises: The Case of Greece.

    ERIC Educational Resources Information Center

    Xirotiri-Kufidu, Stella

    1993-01-01

    Evidence from foreign-owned companies in Greece suggests that cultural patterns and environmental influences cannot be ignored. However, such companies could influence human resource development in a developing country by following their home policies in training and staffing. (SK)

  5. 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

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

    PubMed

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

    2017-07-01

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

  7. A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial

    PubMed Central

    Goldfien, Robert; Pressman, Alice; Jacobson, Alice; Ng, Michele; Avins, Andrew

    2016-01-01

    Context: Relatively few patients with gout receive appropriate treatment. Objective: To determine whether a pharmacist-staffed gout management program is more effective than usual care in achieving target serum uric acid (sUA) levels in gout patients. Design: A parallel-group, randomized controlled trial of a pharmacist-staffed, telephone-based program for managing hyperuricemia vs usual care. Trial duration was 26 weeks. Main Outcome Measures: Primary outcome measure was achieving sUA levels at or below 6 mg/dL at the 26-week visit. Secondary outcome was mean change in sUA levels in the control and intervention groups. Participants were adults with recurrent gout and sUA levels above 6.0 mg/dL. Participants were randomly assigned to management by a clinical pharmacist following protocol or to monitoring of sUA levels but management of their gout by their usual treating physician. Results: Of 102 patients who met eligibility criteria, 77 subjects obtained a baseline sUA measurement and were entered into the trial. Among 37 participants in the intervention group, 13 (35%) had sUA levels at or below 6.0 mg/dL at 26 weeks, compared with 5 (13%) of 40 participants in the control group (risk ratio = 2.8, 95% confidence interval [CI] = 1.1 to 7.1, p = 0.03). The mean change in sUA levels among controls was +0.1 mg/dL compared with −1.5 mg/dL in the intervention group (sUA difference = −1.6, 95% CI = −0.9 to −2.4, p < 0.001). Conclusions: A structured pharmacist-staffed program was more effective than usual care for achieving target sUA levels. These results suggest a structured program could greatly improve gout management. PMID:27352414

  8. Differentiated Staffing.

    ERIC Educational Resources Information Center

    Allen, Dwight W.; Kline, Lloyd W.

    The traditional educational structure requires the teacher to be part bookkeeper, part clerical assistant, and part psychologist, among other roles, while his salary scale is based on length of service. Differentiated staffing offers ways of changing this pattern. The details of differentiated duties are largely a matter of local option and…

  9. 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.

  10. Managing Resource Uncertainty through Academic Staffing in Four-Year Colleges and Universities. ASHE 1985 Annual Meeting Paper.

    ERIC Educational Resources Information Center

    Bagshaw, Marque

    The use of college staffing strategies to reduce staffing expenditures, to reallocate staffing resources, or to limit the time commitment of resources to a position is discussed, based on the literature and data from the Project on Reallocation in Higher Education. Control of the decision to create a position or hire replacements for departing…

  11. 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

  12. Nursing home spending, staffing, and turnover.

    PubMed

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

    2007-01-01

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

  13. 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.…

  14. 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.…

  15. 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.

  16. Staffing Ideas.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1987

    1987-01-01

    Presents relevant ideas to administrators on the topics of employee needs and concerns, rule-making, pep talks, secretary-employer relationship, leading versus managing, requests for raises, employee group burn-out, dealing with anger. (NH)

  17. 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…

  18. Directive Management Procedures, Staffing Patterns in Education for Emotionally Disturbed Students.

    ERIC Educational Resources Information Center

    DeYoung, Michael

    A systematic procedure is outlined which gives guidance to therapists and teachers in managing seriously emotionally disturbed (SED) students (9 to 18 years old) who reside at a licensed children's institution or are attending a centralized public school facility for SED students. Among findings from a review of the literature was that intensive…

  19. 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…

  20. Analysis of Academic Staffing Policies.

    ERIC Educational Resources Information Center

    Bloomfield, Stefan D.

    1980-01-01

    Large-scale Markov chain models and Monte Carlo simulation, two types of models useful for academic managers to analyze academic staffing policies, are described. Their relative advantages and disadvantages regarding technical requirements and performance, as well as managerial usefulness at different levels of the university, are discussed.…

  1. Analysis of Academic Staffing Policies.

    ERIC Educational Resources Information Center

    Bloomfield, Stefan D.

    1980-01-01

    Large-scale Markov chain models and Monte Carlo simulation, two types of models useful for academic managers to analyze academic staffing policies, are described. Their relative advantages and disadvantages regarding technical requirements and performance, as well as managerial usefulness at different levels of the university, are discussed.…

  2. Top Nurse-Management Staffing Collapse and Care Quality in Nursing Homes

    PubMed Central

    Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.

    2014-01-01

    Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943

  3. An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center

    PubMed Central

    Hall, Anna M.; Roane, Teresa E.; Mistry, Reena

    2012-01-01

    Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM. Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center. Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively). Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future. PMID:22919086

  4. Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service.

    PubMed

    Soti, Akos; Temesvari, Peter; Hetzman, Laszlo; Eross, Attila; Petroczy, Andras

    2015-01-09

    In 2011 the Hungarian Air Ambulance Nonprofit Limited Company introduced a new Rapid Sequence Intubation standard operating procedure using a template from London's Air Ambulance. This replaced a previous ad-hoc and unsafe prehospital advanced airway management practice. It was hoped that this would increase clinical standards including internationally comparable results. All Rapid Sequence Intubations performed by the units of the Hungarian Air Ambulance under the new procedure between June 2011 and November 2013 were reviewed in a retrospective database analysis. During this period the air ambulance units completed 4880 missions with 433 intubations performed according to the new procedure. The rate of intubations that were successful on first attempt was 95.4% (413), while intubation was successful overall in 99.1% (429) of the cases; there was no failed airway. 90 complications were noted with 73 (16.9%) patients. Average on scene time was 49 minutes (ranging between: 15-110 minutes). This data shows that it is possible to effectively change a system that was in place for decades by implementing a new robust system that is based on a good template.

  5. Oregon nurse staffing law: is it working?

    PubMed

    Seago, Jean Ann; Davidson, Sue; Waldo, Diane

    2012-03-01

    In 2001, Oregon enacted a law mandating the creation of hospital nurse staffing committees to oversee staffing in acute care hospitals. The study design is a descriptive case study (qualitative method) using semistructured interviews and focus groups to assess the law requiring hospital nurse staffing committees to monitor nurse staffing in Oregon. One significant theme of the study was the wide variation among facilities in the way the staffing legislation is viewed, interpreted, understood, appreciated, and implemented. Another was that the chief nursing officer's view of the legislation tended to be the prevailing view expressed by the managers and staff nurses from those same organizations. A significant difference between a functional versus nonfunctional committee was whether the chief nurse viewed the legislation in a positive way and was using the legislation to enhance his/her work.

  6. 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.

  7. 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.

  8. 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…

  9. 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…

  10. Staffing for Success: 1994 School Library Staffing Survey.

    ERIC Educational Resources Information Center

    Sadowski, Michael; Meyer, Randy

    1994-01-01

    Discusses results of a survey of state-level school library officials conducted via fax to determine statewide school enrollments, funding, media center staffing, state-mandated minimum levels of staffing for school libraries, the ratio of students per school library media specialists, staffing standards, staff shortages, and technology and…

  11. Advanced airway management in an anaesthesiologist-staffed Helicopter Emergency Medical Service (HEMS): A retrospective analysis of 1047 out-of-hospital intubations.

    PubMed

    Piegeler, Tobias; Neth, Philippe; Schlaepfer, Martin; Sulser, Simon; Albrecht, Roland; Seifert, Burkhardt; Spahn, Donat R; Ruetzler, Kurt

    2016-08-01

    Airway management in the out-of-hospital emergency setting is challenging. Failed and even prolonged airway management is associated with serious clinical consequences, such as desaturation, bradycardia, airway injuries, or aspiration. The overall success rate of tracheal intubation ranges between 77% and 99%, depending on the level of experience of the provider. Therefore, advanced airway management should only be performed by highly-skilled and experienced providers. 9765 patients were treated in the out-of-hospital emergency setting by the anaesthesiologist-staffed Helicopter Emergency Medical Services (HEMS) between 2002 and 2014. Patients successfully intubated upon the first attempt were compared to patients who required more than one intubation attempts regarding several potential confounding factors such as age, gender, on-going CPR, NACA Score, initial GCS, prior administration of anaesthetic drugs, neuromuscular blocking agents, and vasopressors. 1573 out of 9765 patients (16.1%) required advanced airway management. 459 patients had already been intubated upon arrival of the HEMS, whereas 1114 patients (11.4%) underwent advanced airway management by the HEMS physician. 67 patients had to be excluded. Data for the remaining 1047 patients (790 males and 257 females) were analyzed further. Primary use of an alternative airway device was reported in 59 patients (5.6%), whereas 988 patients (94.4%) underwent laryngoscopy-guided tracheal intubation. 952 patients (96.4%) could be intubated upon the first attempt and overall intubation success was 99.5% (983 out of 988). Our study demonstrates that HEMS physicians performed airway management frequently and that both the first attempt as well as the overall success rate of tracheal intubation was high. Together with the fact that all failed and difficult intubations were successfully recognized and handled and that no surgical airway had to be established, the current study once more underlines the importance of

  12. Differentiated Staffing and Practice

    ERIC Educational Resources Information Center

    Christie, Kathy

    2005-01-01

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

  13. Differentiated Staffing: The Second Generation.

    ERIC Educational Resources Information Center

    Mann, Peter B.

    This paper describes two approaches to differentiated staffing. The first approach involved reorganizing teacher staffing by creating a career ladder to permit hierarchical staffing without freezing faculty in positions that would limit growth, fix rewards, and destroy morale. The career ladder allowed the use of teachers and paraprofessionals in…

  14. 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…

  15. 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…

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

    PubMed

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

    2015-01-01

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

  17. Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

    PubMed

    Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

    2015-11-06

    Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in

  18. Results of a retrospective observational study of intermediate care staffed by hospitalists: impact on mortality, co-management, and teaching.

    PubMed

    Lucena, Juan Felipe; Alegre, Félix; Rodil, Raquel; Landecho, Manuel Fortún; García-Mouriz, Alberto; Marqués, Margarita; Aquerreta, Irene; García, Nicolás; Quiroga, Jorge

    2012-01-01

    Hospitalized patients are complex and institutions have to face the high cost of critical care and the limited resources of the ward. Intermediate care appears as an attractive strategy to provide rational care according to patient needs. It is an interesting scenario to expand co-management and teaching. Retrospective observational study. Intermediate care unit (ImCU) of a single academic hospital. 456 patients admitted from April 2006 to April 2010 were included in the study. Demographics, admission physiologic parameters and in-hospital mortality were recorded. We used the Simplified Acute Physiology Score II (SAPS II) as prognostic score system. Co-management with medical and surgical teams, and the number of training residents were evaluated. In-hospital mortality was 20.6%, whereas the expected mortality was 23.2% based on SAPS II score. The correlation between SAPS II predicted and observed death rates was accurate and statistically significant (Rho = 1.0, p < 0.001). Co-management was performed with several medical and surgical teams, with an increase in perioperative comanagement of 22.7% (p = 0.014). The number of training residents in ImCU increased from 4.3% to 30.4% (p = 0.002) An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co-management and teaching opportunities at this unique level of care. Copyright © 2012 Society of Hospital Medicine.

  19. The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

    PubMed

    Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

    2017-07-01

    Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

  20. Impact of staffing parameters on operational reliability

    SciTech Connect

    Hahn, H.A.; Houghton, F.K.

    1993-02-01

    This paper reports on a project related to human resource management of the Department of Energy`s (DOE`s) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment safety, and health concerns. For the of the current paper, human resource management activities are identified as ``Staffing`` and include the of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability. The work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development.

  1. Impact of staffing parameters on operational reliability

    SciTech Connect

    Hahn, H.A.; Houghton, F.K.

    1993-01-01

    This paper reports on a project related to human resource management of the Department of Energy's (DOE's) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment safety, and health concerns. For the of the current paper, human resource management activities are identified as Staffing'' and include the of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability. The work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development.

  2. Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study

    PubMed Central

    Lukewich, Julia; Edge, Dana S.; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

    2016-01-01

    Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Methods: Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio. Results: Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively). Interpretation: The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting

  3. 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.

  4. Pre-implementation studies of a workforce planning tool for nurse staffing and human resource management in university hospitals.

    PubMed

    van Oostveen, Catharina J; Ubbink, Dirk T; Mens, Marian A; Pompe, Edwin A; Vermeulen, Hester

    2016-03-01

    To investigate the reliability, validity and feasibility of the RAFAELA workforce planning system (including the Oulu patient classification system - OPCq), before deciding on implementation in Dutch hospitals. The complexity of care, budgetary restraints and demand for high-quality patient care have ignited the need for transparent hospital workforce planning. Nurses from 12 wards of two university hospitals were trained to test the reliability of the OPCq by investigating the absolute agreement of nursing care intensity (NCI) measurements among nurses. Validity was tested by assessing whether optimal NCI/nurse ratio, as calculated by a regression analysis in RAFAELA, was realistic. System feasibility was investigated through a questionnaire among all nurses involved. Almost 67 000 NCI measurements were performed between December 2013 and June 2014. Agreement using the OPCq varied between 38% and 91%. For only 1 in 12 wards was the optimal NCI area calculated judged as valid. Although the majority of respondents was positive about the applicability and user-friendliness, RAFAELA was not accepted as useful workforce planning system. Nurses' performance using the RAFAELA system did not warrant its implementation. Hospital managers should first focus on enlarging the readiness of nurses regarding the implementation of a workforce planning system. © 2015 John Wiley & Sons Ltd.

  5. An Evaluative Study of the Navy Medical Department’s Patient Classification System and Staffing Allocation System. (The Workload Management System for Nursing)

    DTIC Science & Technology

    1985-12-01

    15 SECTION Page f. Correlation Between Charge Nurses’ Perceptions of the Quality of Nursing Care Given, Staffing Adequacy, and Recommended...OF FIGURES Figure Page 1. Relationship of Charge Nurses Perceptions of Quality of Nursing Care Given with the Workload Index...nurses completed a Nursing Care Evaluation Form. A demographic questionnaire to characterize the respondents and obtain feedback on perceptions of

  6. Computerized nursing staffing: a software evaluation.

    PubMed

    Pereira, Irene Mari; Gaidzinski, Raquel Rapone; Fugulin, Fernanda Maria Togeiro; Peres, Heloísa Helena Ciqueto; Lima, Antônio Fernandes Costa; Castilho, Valéria; Mira, Vera Lúcia; Massarollo, Maria Cristina Komatsu Braga

    2011-12-01

    The complexity involved in operationalizing the method for nursing staffing, in view of the uncountable variable related to identifying the workload, the effective working time of the staff, and the Technical Security Index (TSI) revealed the need to develop a software program named: Computerized Nursing Staffing (DIPE, in Portuguese acronyms). This exploratory, descriptive study was performed with the objective to evaluate the technical quality and functional performance of DIPE. Participants were eighteen evaluators, ten of whom where nurse faculty or nurse hospital unit managers, and eight health informatics experts. The software evaluation was performed according to norm NBR ISO/IEC 9126-1, considering the features functionality, reliability, usability, efficiency, and maintainability. The software evaluation reached positive results and agreement among the evaluators for all the evaluated features. The reported suggestions are important for proposing further improving and enhancing the DIPE.

  7. 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

  8. What to do when your medical practice is short-staffed: a staff training tool.

    PubMed

    Hills, Laura Sachs

    2009-01-01

    It's first thing in the morning, the day's appointment schedule is jam-packed, and you just found out that you're going to be short-staffed. After the initial panic wears off what are you and your co-workers going to do? How will you manage to work through your day with fewer people on hand? This article suggests a three-pronged approach to the challenge of medical practice short-staffing. It offers practical tips for avoiding short-staffed days by creating firm policies for staff absences, tardiness, and vacations. This article also describes how cross-training employees, working with temporary employees, and other preparation will make short-staffed days more manageable. Finally, this article provides 10 practical tips for coping with the short-staffed day. It offers helpful advice to any medical practice employee who finds himself or herself feeling overwhelmed by a short-staffed day.

  9. The Impact of State Nursing Home Staffing Standards on Nurse Staffing Levels.

    PubMed

    Paek, Seung Chun; Zhang, Ning J; Wan, Thomas T H; Unruh, Lynn Y; Meemon, Natthani

    2016-02-01

    This study investigated the impact of state nursing home staffing standards on nurse staffing levels for the year 2011. Specifically, the study attempted to measure state staffing standards at facility level (i.e., nurse staffing levels that each individual nursing home must retain by its state staffing standards) and analyzed the policy impact. The study findings indicated that state staffing standards for the categories of registered nurse, licensed nurse, or total nurse are positively related to registered nurse, licensed nurse, or total nurse staffing levels, respectively. Nursing homes more actively responded to licensed staffing requirements than total staffing requirements. However, nursing homes did not increase their staffing levels as much as those required by state staffing standards. It is possibly because the quality-oriented inspection allows flexibility in nursing homes' control of nurse staffing levels. © The Author(s) 2015.

  10. Random fluctuations and validity in measuring disease management effectiveness for small populations.

    PubMed

    Farah, J Ramsay; Kamali, Kyahn; Harner, Jeffrey; Duncan, Ian G; Messer, Thomas C

    2008-12-01

    One objective of a disease management (DM) program is the reduction of members' claims costs. A considerable amount of effort has been dedicated to standardizing the outcomes of DM measurement. An area that has not received as much attention is that of random fluctuations in measured outcomes and the related issue of the validity of outcomes subject to random fluctuation. From year to year, large random fluctuations in claims costs can increase or reduce actual savings from a DM program. Sponsors of DM programs want to know how large a group or sample is necessary to prevent the effect of random fluctuations from overwhelming the effect of claims reductions. In this paper, we measure the fluctuations in calculated DM savings in a large commercial population using an adjusted historical control methodology--the methodology that has become the industry standard and which is codified by DMAA's Guidelines. We then determine the sample size necessary to demonstrate DM program savings at different levels of confidence and model the effect on fluctuations in observed outcomes under different methods of choosing trend, different levels of truncation, and for different estimates of program savings. Some groups, particularly employers, will be smaller than the minimum size required for credible outcomes measurement. For groups smaller than this minimum size, we suggest a utilization-based outcomes measure that can be used as a proxy. For both claims- and utilization-based calculations, we provide confidence intervals to be placed around savings estimates. We do this for group sizes ranging from 1000 to 100,000 members.

  11. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Special staffing payments. 9701.363 Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363...

  12. Mindful staffing: a qualitative description of charge nurses' decision-making behaviors.

    PubMed

    Wilson, Deleise S; Talsma, AkkeNeel; Martyn, Kristy

    2011-10-01

    Patient outcomes are linked to nurse staffing. Although charge nurses are responsible for intrashift staffing decisions, little is known about their decision-making behaviors. This study describes the behaviors of charge nurses from the perspective of charge nurses, nurse managers, and staff nurses. This qualitative descriptive study was conducted with a sample of 24 nurses. The findings revealed that staffing the unit was the most important role for charge nurses. Charge nurses reported spending up to 90% of a shift resolving intrashift staffing issues. Five effective decision-making behaviors emerged: (a) resourcefulness, (b) tactful communication, (c) flexibility, (d) decisiveness, and (e) awareness of the big picture. These behaviors of charge nurses are similar to mindful behaviors of workers in hazardous work environments, and are therefore described as mindful staffing. Practice implications and considerations for the education of charge nurses in relation to safe intrashift staffing are suggested by the findings of this study.

  13. 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.

  14. The staffing shortage: AHRA responds.

    PubMed

    Olivi, Penny M

    2002-01-01

    The AHRA Board of Directors formed a Long-Term Staffing Task Force to study the question, "Should AHRA become involved in the resolution(s) of the current staffing crisis, and if so how?" Because the background information that could be gathered was extensive, the Task Force used the following four questions to guide its activity: SENSITIVITY TO MEMBERS' VIEWS: What do we know about the needs, wants and preferences of our members, prospective members and customers relevant to a decision to become involved in activities to resolve the staffing crisis? FORESIGHT ABOUT FUTURE ENVIRONMENT: What do we know about the current and evolving dynamics of our profession relevant to a decision to become involved in activities to resolve the staffing crisis? INSIGHT INTO THE ORGANIZATION: What do we know about the strategic position and internal capacity of our organization relevant to a decision to become involved in activities to resolve the staffing crisis? CONSIDERATION OF OUR CHOICES: What are the ethical implications of our choices relevant to a decision to become involved in activities to resolve the staffing crisis? After considerable investigation and discussion, the Task Force made the following recommendations to the Board: RAISE AWARENESS OF OUR PROFESSION: Expand the number of radiologic technologists in the workforce by increasing the diversity of our students and by changing the traditional method in which we educate students (i.e., full-time, day clinical education). Create a quality monitor useful to the majority of radiology leaders to begin to systematically document the shortage. Support limited licensure and/or create a defined position of "staff extender" for radiologic technology.

  15. Developing strategies for on-call staffing: a working guideline for safe practices.

    PubMed

    Olmstead, John; Falcone, Deborah; Lopez, Jacy; Mislan, Linda; Murphy, Marialena; Acello, Toni

    2014-10-01

    Effective on-call clinical staffing is critical to providing perioperative services to patients requiring emergency surgical care. Without careful monitoring of continuous work hours and hours worked per week, staffing practices can adversely affect the ability of personnel to function and provide care. Managers and perioperative personnel must carefully evaluate their on-call schedule to ensure the provision of safe medical care for their patients. Perioperative leaders at two hospitals partnered to create a safety guideline for on-call staffing practices, which includes zone guides for determining workload intensity. This guideline has served to help managers evaluate the general safety of their staffing plan and identify on-call practices that may need improvement or support in their areas of responsibility. Key recommendations from the guideline can help perioperative managers at other facilities establish clinical staffing plans and on-call practices that are safe and effective.

  16. Nurse Staffing Requirements and Related Topics: A Selected Bibliography. Nurse Planning Information Series No. 9.

    ERIC Educational Resources Information Center

    Franklin Research Center, Philadelphia, PA.

    Recent literature on the changing staffing requirements for registered nurses and the factors affecting those requirements is cited in this annotated bibliography that comprises the ninth volume in the Nurse Planning Information Series. A broad concept of staffing is employed and includes information useful to both managers within individual…

  17. 10 CFR 719.16 - When must the staffing and resource plan be submitted?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Management Plan § 719.16 When must the staffing and resource plan be submitted? (a) For significant matters... matters, the contractor or Department retained counsel must submit the staffing and resource plan within... the matter. (d) When it is unclear whether a matter is significant, the contractor must consult with...

  18. 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…

  19. 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…

  20. Nursing home staffing, turnover, and case mix.

    PubMed

    Harrington, Charlene; Swan, James H

    2003-09-01

    This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.

  1. Staffing Up for Technology Support.

    ERIC Educational Resources Information Center

    Carter, Kim

    2000-01-01

    Examines current technology staffing in school districts and compares technology-related roles with a similar study conducted in 1997. Discusses job titles; responsibilities; career paths; lack of technology support in schools; district-level support; teacher training; peer assistance; student roles; collaboration with library media specialists;…

  2. Differentiated Staffing: Expectations and Pitfalls.

    ERIC Educational Resources Information Center

    Barbee, Don

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

  3. 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

    ... Employment and Training Administration Plumchoice, Inc., Including On-Site Leased Workers From Balance..., Inc., including on-site leased workers from Balance Staffing, Insight Global Staffing, and... from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who became...

  4. 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.

  5. 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…

  6. 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…

  7. Staffing the Student Affairs Division: Theory, Practices, and Issues.

    ERIC Educational Resources Information Center

    Carpenter, D. Stanley; Torres, Vasti; Winston, Roger B., Jr.

    2001-01-01

    The staffing process in student affairs is one of the most important leadership and management functions that administrators are called upon to perform. How well the interrelated functions of recruitment, selection, orientation, supervision, performance appraisal, professional development, and departure by staff are handled determines the…

  8. Patient acuity and nurse staffing challenges in Norwegian neonatal intensive care units.

    PubMed

    Ohnstad, Mari O; Solberg, Marianne T

    2017-07-11

    To describe fluctuations in patient numbers, patient acuity and the need for nurses in neonatal intensive care units based on population data. Neonatal intensive care units are difficult to staff appropriately due to fluctuations in patient volume and acuity. Staffing guidelines have been developed and applied in some countries to offer the neonatal population safe patient care. National data were used to describe patient load and acuity for two consecutive years. The need for nurses was calculated by combining these data with guidelines for nurse staffing. A total of 11.3% of all neonatal patients in Norway were categorised as intensive care patients. There were no differences in the need for nurses in weekends vs. weekdays or during summer holidays vs. days in the rest of the year. Small units have increased variability in staffing needs, and sufficient staffing is more challenging compared to that of larger units. Planning for reduced staffing for weekends and summer seasons is ineffective. Staffing planned for most of the days in a year instead of the median need for nurses will result in a greater increase in the need for nurses in small units compared to larger units. © 2017 John Wiley & Sons Ltd.

  9. Nurse staffing and NICU infection rates.

    PubMed

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

    2013-05-01

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

  10. Negotiating safety when staffing falls short.

    PubMed

    Zolnierek, Cindy Diamond; Steckel, Cynthia M

    2010-06-01

    Adequate nurse staffing is inextricably linked to patient outcomes and, although optimal staffing levels for inpatient hospital units are widely debated, staffing standards for critical care areas such as intensive care units may be less variable. Even established staffing levels cannot guarantee adequate staffing. The nursing workforce shortage has affected all areas of nursing practice, but perhaps no area more severely than critical care. New treatments and procedures increase the number of individuals requiring intensive inpatient care and emergency rooms receive increased requests for nonemergent as well as critical care. There are times when staffing fails to meet desired levels and nurses are challenged to meet their duty to the patient for safety. The purpose of this article is to identify the safety challenges posed when staffing levels are less than planned in critical care settings and discuss individual, organizational, and policy-oriented strategies for protecting patient safety.

  11. 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.

  12. 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.

  13. Nursing's role and staffing in accountable care.

    PubMed

    Mensik, Jennifer S

    2013-01-01

    Nurse staffing in a world of health care reform and accountable care is uncertain and creates fear not only for the nurse leaders, but all RNs. As health care reform transforms the environment, so must the role and staffing of nurses. There is still not one right answer or agreed upon manner to nurse staffing of inpatient units. This leaves nurses free to imagine roles and staffing possibilities for the future across the continuum. Including all RNs in conversations, visioning, and problem solving for the future will best prepare the profession for our role in caring for our patients.

  14. Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees.

    PubMed

    Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti

    2015-08-01

    This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.

  15. Audit of staffing requirements at the Westinghouse Savannah River Company

    SciTech Connect

    Not Available

    1994-01-25

    The Westinghouse Savannah River Company operates the Savannah River Site for the US Department of Energy (Department) under a cost-plus-award-fee contract. Department policies require contractors to ensure a high level of performance in operating Department facilities by establishing operating standards, assessing performance against such standards, and holding contractor employees accountable for their performance. The purpose of the audit was to review Westinghouse`s policies and practices for determining staffing requirements. Since assuming responsibility for the Savannah River Site in 1989, Westinghouse increased its staffing by over 4,000 employees. The Department had undertaken some actions to reduce the number of contractor employees at the Savannah River Site. Our audit showed that the use of industry and federal performance work standards in its construction and management activities could enable Westinghouse to further reduce its staff by over 1,800 employees. The potential savings in salaries and benefits associated with such action could be about $399 million over a 5-year period. Additional staffing reductions could be attained through the use of engineered time standards in the maintenance and fabrication shops. In addition, Westinghouse significantly understated, in periodic reports to the Department, the personnel resources applied to accomplish contract requirements. Of course, the actual staffing reductions realized would be largely determined by the manner in which the work standards are implemented and the levels of proficiency attained by the workforce.

  16. Coping strategies to manage stress related to vision loss and fluctuations in retinitis pigmentosa

    PubMed Central

    Bittner, Ava K.; Edwards, Lori; George, Maureen

    2010-01-01

    Background Vision loss in retinitis pigmentosa (RP) is a slowly progressive and inexorable threat to patients’ independence. It is not surprising that RP patients, many of whom are young when diagnosed, are at high risk for stress related to their vision loss. To address these issues, eye care providers need to be aware of what coping strategies RP patients use to successfully manage their vision loss. Methods We held focus groups with eight legally blind RP patients to help us better understand how they cope with the stress that is generated from their progressive vision loss and fluctuations in vision. Focus group sessions were audiotaped and resulting notes were coded using conventional qualitative analytic techniques. Results Two themes were identified: 1) “kicking and screaming” captured the ways in which RP patients fight to maintain their independence in the face of worsening vision; and 2) “there are so many worse things” describes how RP patients keep their vision loss in perspective. These RP patients demonstrated high levels of resiliency. In particular, they often used humor as a coping mechanism. Conclusions Understanding the ways in which RP patients manage their gradual, impending vision loss may lead to improved quality of care for this patient population. PMID:20591747

  17. 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…

  18. Sticker shock at the hospital. Freed from reins of managed care, hospitals accelerate price hikes for fourth consecutive year; blame placed on staffing, tech costs.

    PubMed

    Jaklevic, Mary Chris

    2003-01-20

    Free from the shackles of managed care, the nation's hospitals boosted prices for the fourth consecutive year, according to a new report released by the government last week. David Cyganowski, left, a managing director at Salomon Smith Barney, says if taxes on dividends are wiped out, hospitals could be confronted with higher long-term interest rates.

  19. 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…

  20. Flexibility in Academic Staffing: Effective Policies and Practices. ASHE-ERIC Higher Education Report No. 1, 1985.

    ERIC Educational Resources Information Center

    Mortimer, Kenneth P.; And Others

    Academic staffing practices used at four-year colleges and universities are identified, and recommendations are offered for achieving staffing flexibility in the face of conditions such as scarce resources. In addition to considering faculty flow models (e.g., Markov models and simulators) as a management/planning tool to evaluate personnel and…

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. 42 CFR 9.9 - Facility staffing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 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...

  6. 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…

  7. 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…

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

    PubMed

    Havig, Anders Kvale; Skogstad, Anders; Kjekshus, Lars Erik; Romøren, Tor Inge

    2011-11-28

    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. 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. 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. 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

  9. 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

  10. 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.

  11. Refraining from pre-hospital advanced airway management: a prospective observational study of critical decision making in an anaesthesiologist-staffed pre-hospital critical care service.

    PubMed

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-10-25

    We report prospectively recorded observational data from consecutive cases in which the attending pre-hospital critical care anaesthesiologist considered performing pre-hospital advanced airway management but decided to withhold such interventions. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) registered data from February 1st 2011 to October 31st 2012. Included were patients of all ages for whom pre-hospital advanced airway management were considered but not performed. The main objectives were to investigate (1) the pre-hospital critical care anaesthesiologists' reasons for considering performing pre-hospital advanced airway management in this group of patients (2) the pre-hospital critical care anaesthesiologists' reasons for not performing pre-hospital advanced airway management (3) the methods used to treat these patients (4) the incidence of complications related to pre-hospital advanced airway management not being performed. We registered data from 1081 cases in which the pre-hospital critical care anaesthesiologists' considered performing pre-hospital advanced airway management. The anaesthesiologists decided to withhold pre-hospital advanced airway management in 32.1% of these cases (n = 347). In 75.1% of these cases (n = 257) pre-hospital advanced airway management were withheld because of the patient's condition and in 30.8% (n = 107) because of patient co-morbidity. The most frequently used alternative treatment was bag-mask ventilation, used in 82.7% of the cases (n = 287). Immediate complications related to the decision of not performing pre-hospital advanced airway management occurred in 0.6% of the cases (n = 2). We have illustrated the complexity of the critical decision-making associated with pre-hospital advanced airway management. This study is the first to identify the most common reasons why pre-hospital critical care

  12. 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.

  13. Hospital Nurse Staffing: Choice of Measure Matters

    PubMed Central

    Kalisch, Beatrice; Friese, Christopher R.; Choi, Seung Hee; Rochman, Monica

    2012-01-01

    Background Researchers frequently use nurse staffing measures to examine hospital quality of care. Measure choices include nurse-reported perception of staffing adequacy, nurse-reported patient workloads, and empirically-derived hours per patient day (HPPD). Objective To examine the correlations across these measures and identify factors associated with these staffing measures. Design, Settings, and Subjects A cross-sectional correlational study of 92 medical-surgical, rehabilitation, and intermediate in 11 acute care hospitals. Methods We surveyed registered nurses on their perceived staffing adequacy, last shift patient workload, and unit-level structures and processes of care delivery. Individual responses to these measures were aggregated to the nursing unit level, and unit-level HPPD, unit-level case mix index (CMI) were obtained from each hospital’s administrative data. After examining the correlation matrix across variables, those associated with the three staffing measures were then examined using linear regression. Results HPPD and the nurse-reported patient workload on last shift were correlated (r=−.276, p=.008), and perceptions of the adequacy of staffing and nurse-reported patient workload on last shift were correlated (r=−.384, p=.000). In multivariable analyses, inadequate numbers of assistive personnel was significantly associated with both perceived staffing adequacy and nurse-reported patient loads. Unit-level CMI was significantly associated with both HPPD and nurse-reported patient loads. These data suggest that the three measures of nurse staffing are not highly correlated, and may capture different elements of the unit context to explain nurse staffing. Researchers should consider the correlates of these measures when selecting nurse staffing measures for future investigations. PMID:21666511

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

    PubMed

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

    2006-10-01

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

  15. 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

  16. Optimizing outpatient phlebotomy staffing: tools to assess staffing needs and monitor effectiveness.

    PubMed

    Mijailovic, Aleksandar S; Tanasijevic, Milenko J; Goonan, Ellen M; Le, Rachel D; Baum, Jonathan M; Melanson, Stacy E F

    2014-07-01

    Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care. To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows. We used staffing levels and patient venipuncture volumes to derive the estimated capacity, a parameter that helps predict the number of patients a location can accommodate per unit of time. We then used this parameter to determine whether a particular phlebotomy site was overstaffed, adequately staffed, or understaffed. Patient wait-time and satisfaction data were collected to assess the efficacy and accuracy of the staffing tool after implementing the staffing changes. In this article, we present the applications of our approach in 1 overstaffed and 2 understaffed phlebotomy sites. After staffing changes at previously understaffed sites, the percentage of patients waiting less than 10 minutes ranged from 88% to 100%. At our previously overstaffed site, we maintained our goal of 90% of patients waiting less than 10 minutes despite staffing reductions. All staffing changes were made using existing resources. Used in conjunction with patient wait-time and satisfaction data, our outpatient phlebotomy staffing tool is an accurate and flexible way to assess capacity and to improve patient wait times.

  17. 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%.

  18. Inconsistent year-to-year fluctuations limit the conclusiveness of global higher education rankings for university management

    PubMed Central

    Sorz, Johannes; Wallner, Bernard; Seidler, Horst

    2015-01-01

    Backround. University rankings are getting very high international media attention, this holds particularly true for the Times Higher Education Ranking (THE) and the Shanghai Jiao Tong University’s Academic Ranking of World Universities Ranking (ARWU). We therefore aimed to investigate how reliable the rankings are, especially for universities with lower ranking positions, that often show inconclusive year-to-year fluctuations in their rank, and if these rankings are thus a suitable basis for management purposes. Methods. We used the public available data from the web pages of the THE and the ARWU ranking to analyze the dynamics of change in score and ranking position from year to year, and we investigated possible causes for inconsistent fluctuations in the rankings by the means of regression analyses. Results. Regression analyses of results from the THE and ARWU from 2010–2014 show inconsistent fluctuations in the rank and score for universities with lower rank positions (below position 50) which lead to inconsistent “up and downs” in the total results, especially in the THE and to a lesser extent also in the ARWU. In both rankings, the mean year-to-year fluctuation of universities in groups of 50 universities aggregated by descending rank increases from less than 10% in the group of the 50 highest ranked universities to up to 60% in the group of the lowest ranked universities. Furthermore, year-to-year results do not correspond in THES- and ARWU-Rankings for universities below rank 50. Discussion. We conclude that the observed fluctuations in the THE do not correspond to actual university performance and ranking results are thus of limited conclusiveness for the university management of universities below a rank of 50. While the ARWU rankings seems more robust against inconsistent fluctuations, its year to year changes in the scores are very small, so essential changes from year to year could not be expected. Furthermore, year-to-year results do not

  19. Inconsistent year-to-year fluctuations limit the conclusiveness of global higher education rankings for university management.

    PubMed

    Sorz, Johannes; Wallner, Bernard; Seidler, Horst; Fieder, Martin

    2015-01-01

    Backround. University rankings are getting very high international media attention, this holds particularly true for the Times Higher Education Ranking (THE) and the Shanghai Jiao Tong University's Academic Ranking of World Universities Ranking (ARWU). We therefore aimed to investigate how reliable the rankings are, especially for universities with lower ranking positions, that often show inconclusive year-to-year fluctuations in their rank, and if these rankings are thus a suitable basis for management purposes. Methods. We used the public available data from the web pages of the THE and the ARWU ranking to analyze the dynamics of change in score and ranking position from year to year, and we investigated possible causes for inconsistent fluctuations in the rankings by the means of regression analyses. Results. Regression analyses of results from the THE and ARWU from 2010-2014 show inconsistent fluctuations in the rank and score for universities with lower rank positions (below position 50) which lead to inconsistent "up and downs" in the total results, especially in the THE and to a lesser extent also in the ARWU. In both rankings, the mean year-to-year fluctuation of universities in groups of 50 universities aggregated by descending rank increases from less than 10% in the group of the 50 highest ranked universities to up to 60% in the group of the lowest ranked universities. Furthermore, year-to-year results do not correspond in THES- and ARWU-Rankings for universities below rank 50. Discussion. We conclude that the observed fluctuations in the THE do not correspond to actual university performance and ranking results are thus of limited conclusiveness for the university management of universities below a rank of 50. While the ARWU rankings seems more robust against inconsistent fluctuations, its year to year changes in the scores are very small, so essential changes from year to year could not be expected. Furthermore, year-to-year results do not correspond

  20. MLA Policy Statements: Salaries and Staffing.

    ERIC Educational Resources Information Center

    ADFL Bulletin, 2003

    2003-01-01

    Provides the Modern Language Association's salary recommendations for entry-level full-time and part-time foreign language department faculty, as well as general staffing recommendations. (Author/VWL)

  1. 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

  2. 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.

  3. Nurse burnout in China: a questionnaire survey on staffing, job satisfaction, and quality of care.

    PubMed

    Lu, Minmin; Ruan, Hui; Xing, Weijie; Hu, Yan

    2015-05-01

    The investigators examined how nurse staffing affects nurse job satisfaction and quality of care. Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China. A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care. The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82). Nurse staffing is associated with job dissatisfaction and quality of care. Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects. © 2013 John Wiley & Sons Ltd.

  4. 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

  5. Staffing benchmarks for histology laboratories.

    PubMed

    Buesa, René J

    2010-06-01

    This article summarizes annual workloads for staff positions and work flow productivity (WFP) values from 247 human pathology, 31 veterinary, and 35 forensic histology laboratories (histolabs). There are single summaries for veterinary and forensic histolabs, but the data from human pathology are divided into 2 groups because of statistically significant differences between those from Spain and 6 Hispano American countries (SpHA) and the rest from the United States and 17 other countries. The differences reflect the way the work is organized, but the histotechnicians and histotechnologists (histotechs) from SpHA have the same task productivity levels as those from any other country (Buesa RJ. Productivity standards for histology laboratories. [YADPA 50,552]). The information is also segregated by groups of histolabs with increasing workloads; this aspect also showed statistical differences. The information from human pathology histolabs other than those from SpHA were used to calculate staffing annual benchmarks for pathologists (from 3700 to 6500 cases depending on the histolab annual workload), pathology assistants (20,000 cases), staff histotechs (9900 blocks), cutting histotechs (15,000 blocks), histotechs doing special procedures (9500 slides if done manually or 15,000 slides with autostainers), dieners (100 autopsies), laboratory aides and transcriptionists (15,000 cases each), and secretaries (20,000 cases). There are also recommendations about workload limits for supervisory staff (lead techs and supervisors) and when neither is required. Each benchmark was related with the productivity of the different tasks they include (Buesa RJ. Productivity standards for histology laboratories. [YADPA 50,552]) to calculate the hours per year required to complete them. The relationship between workload and benchmarks allows the director of pathology to determine the staff needed for the efficient operation of the histolab.

  6. 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…

  7. 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…

  8. Technical Staffing Crises and Managing Systems Projects

    ERIC Educational Resources Information Center

    Davis, Charles K.

    2007-01-01

    Case method teaching is not limited to larger, complex cases. It is often useful to supplement classroom discussions with short cases, ones that have been targeted for one or two discussion points that challenge student thinking beyond the usual lecture or textbook. These shorter cases are called "minicases." The objective of a minicase is to…

  9. Defense Contract Management Command Staffing Assistance Model

    DTIC Science & Technology

    1992-05-01

    that in recent years defense business has migrated to the former Atlanta and Dallas regions from other areas. 4-2 SECTION 5 RECOMMENDATIONS 5.1...55.2 69.5 -. Reading 3:.9 33 ~ 3.2 S~ro. 3d 2.5 50.2 8cs~z~.54.5 54.5 - Carzen 3.t 9.9 48., Har-. ! Cd 39.2 43.5 -:. New vz:;k 54.3 42.5 2. Si:,a-.se...RcxQ: Canoga Park,ZA 22.1% GE Ahr :=rat Engitne, Lymnn mA 22.9% General :)vna~j:s, Warren, m: 23.6%Genera. DvYnamics, L~aa, oH 23.9% ,tkc.31.5% mOC

  10. Emerging trends in ICU management and staffing.

    PubMed

    Lustbader, D; Fein, A

    2000-10-01

    It is likely that greater on-site intensivist coverage in critical care units will be observed in the future. Regionalization of critical care services will make this a financial reality because this level of expertise cannot realistically be provided to all hospitals. Perhaps units above a certain size will warrant this level of coverage and smaller community hospitals will transfer patients in need of a very high level of service, which can be provided only by intensivists on site. Community hospitals may rely on specially trained nurse practitioners or physician assistants to provide more on-site coverage during off hours. As technology advances, telemedicine will play a greater role in providing intensivist coverage to ICUs during off hours or to community hospitals in remote areas. Advanced technology and reorganization of critical care services offer opportunities for creative and nontraditional ways to deliver improved care to patients.

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

    PubMed

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

    2016-11-01

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

  12. The occupational health service. Staffing, facilities, and equipment.

    PubMed

    Rieth, L K

    2000-08-01

    An occupational health service can be an integral part of any company. It is incumbent on the industry to conduct a thorough assessment of the need for such a service and then support the service from a financial and resource perspective. Consequently, staffing and equipping an occupational health service adequately are dependent on the services to be delivered and the type of professional staff hired. All occupational health programs can be conducted in a cost effective manner when the goals and mission are in alignment with company goals, management supports appropriate funding, and space supports the delivery of quality health care.

  13. 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

  14. 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.

  15. Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care.

    PubMed

    Davis, Melinda M; Balasubramanian, Bijal A; Cifuentes, Maribel; Hall, Jennifer; Gunn, Rose; Fernald, Douglas; Gilchrist, Emma; Miller, Benjamin F; DeGruy, Frank; Cohen, Deborah J

    2015-01-01

    To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care. Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach. Across the 17 practices, staffing ratios ranged from 1 BHC covering 0.3 to 36.5 primary care clinicians (PCCs). BHC scheduling varied from 50-minute prescheduled appointments to open, flexible schedules slotted in 15-minute increments. However, staffing and scheduling patterns generally clustered in 2 ways and enabled BHCs to be engaged by referral or warm handoff. Five practices predominantly used warm handoffs to engage BHCs and had higher BHC-to-PCC staffing ratios; multiple BHCs on staff; and shorter, more flexible BHC appointment schedules. Staffing and scheduling structures that enabled warm handoffs supported BHC engagement with patients concurrent with the identification of behavioral health needs. Twelve practices primarily used referrals to engage BHCs and had lower BHC-to-PCC staffing ratios and BHC schedules prefilled with visits. This enabled some BHCs to bill for services, but also made them less accessible to PCCs in when patients presented with behavioral health needs during a clinical encounter. Three of these practices were experimenting with open scheduling and briefer BHC visits to enable real-time access while managing resources. Practices' approaches to PCC-BHC staffing, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context. Practice leaders, educators, clinicians, funders, researchers, and policy makers must

  16. 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.

  17. Steady-State Staffing: A Second Report.

    ERIC Educational Resources Information Center

    Furniss, W. Todd

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

  18. Maintenance Staffing Guidelines For Educational Facilities.

    ERIC Educational Resources Information Center

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

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

  19. 42 CFR 1007.13 - Staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Staffing requirements. 1007.13 Section 1007.13 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG... applicable law and procedures and providing effective prosecution or liaison with other prosecutors; (2)...

  20. Report on Staffing and Salaries, Fall 1998.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    The annual report provides demographic, employment, workload, and compensation information on California community college employees. It provides minimal analysis and is designed to provide reference information to persons at the state and district levels who use data on community college staffing for collective bargaining, accreditation reviews,…

  1. Many Variables Determine Campus Safety Staffing Levels

    ERIC Educational Resources Information Center

    Blake, Christopher G.

    2011-01-01

    College and university administrators must take into account a number of variables in determining the appropriate staffing levels for their campus public safety function, according to a white paper released by International Association of Campus Law Enforcement Administrators (IACLEA). The report is entitled, "Establishing Appropriate Staffing…

  2. 42 CFR 1007.13 - Staffing requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Staffing requirements. 1007.13 Section 1007.13 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG... applicable law and procedures and providing effective prosecution or liaison with other prosecutors; (2)...

  3. Many Variables Determine Campus Safety Staffing Levels

    ERIC Educational Resources Information Center

    Blake, Christopher G.

    2011-01-01

    College and university administrators must take into account a number of variables in determining the appropriate staffing levels for their campus public safety function, according to a white paper released by International Association of Campus Law Enforcement Administrators (IACLEA). The report is entitled, "Establishing Appropriate Staffing…

  4. Teacher Unions, School Staffing, and Reform.

    ERIC Educational Resources Information Center

    Johnson, Susan Moore; And Others

    To clarify the role of collective bargaining in defining and reforming local school district staffing policies, an analysis was made of 144 teacher contracts gathered from a stratified, random sample of districts. In five of these districts, selected for their diversity on a number of variables (state, region, size, labor history, contract, and…

  5. 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

  6. 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";…

  7. 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…

  8. Maintenance Staffing Standards for Zero-Based Budgeting.

    ERIC Educational Resources Information Center

    Adams, Matthew C.; And Others

    1998-01-01

    Discusses school preventive maintenance and the variables associated with maintenance staffing standards that address a zero-based budgeting environment. Explores preventive-maintenance measurement for staffing requirements, defines staffing levels and job descriptions, and outlines the factors to consider when creating a maintenance program and…

  9. 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…

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

    ERIC Educational Resources Information Center

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

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

  11. 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…

  12. 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…

  13. Current management of motor fluctuations in patients with advanced Parkinson's disease treated chronically with levodopa.

    PubMed

    Melamed, E; Zoldan, J; Galili-Mosberg, R; Ziv, I; Djaldetti, R

    1999-01-01

    Motor fluctuations after long-term administration of levodopa may be due to central pharmacodynamic mechanisms such as reduced striatal synthesis and storage of dopamine from exogenous levodopa and subsensitization of postsynaptic dopaminergic receptors. Peripheral pharmacokinetic mechanisms may be equally important, particularly in motor fluctuations of the "delayed on" (increased time latencies from dose intake to start-up of clinical benefit) and "no-on" (complete failure of a levodopa dose to exert an "on" response) types. Levodopa itself has a very poor solubility. In addition, there is delayed gastric emptying in many advanced patients. Therefore, an oral dose of levodopa may remain in the stomach for long periods of time before it passes into the duodenum where there is immediate absorption. Consequently, in order to overcome response fluctuations caused by impaired pharmacokinetic mechanisms and to improve its absorption, we recommend that levodopa be taken in multiple small doses, on an empty stomach, preferably crushed and mixed with a lot of liquid. Protein intake should be minimized. Prokinetic drugs such as prepulsid (Cisaprid) could be used to facilitate gastric motility and levodopa transit time. Administration of crushed levodopa through nasoduodenal or gastrojejunostomy tubes may be helpful in certain circumstances. Bypassing the stomach with subcutaneous injections of apomorphine may provide dramatic rescue from difficult "off" situations. Oral and s.c. administration of novel, extremely soluble prodrugs of levodopa, e.g., levodopa ethylester, may offer a new approach to overcome difficulties in levodopa absorption. Addition of dopamine agonists, MAO-B inhibitors, COMT inhibitors and controlled release levodopa preparations may be helpful in prolonging the duration of efficacy of each single levodopa dose. Levodopa, administered orally, usually combined with peripheral dopa decarboxylase inhibitors, continues to be the most widely-used and most

  14. Changes in suicide rates and in mental health staffing in the veterans health administration, 2005-2009.

    PubMed

    Katz, Ira R; Kemp, Janet E; Blow, Frederic C; McCarthy, John F; Bossarte, Robert M

    2013-07-01

    Between 2005 and 2009, the Veterans Health Administration (VHA) enhanced its mental health programs and increased outpatient mental health staffing by 52.8%. However, suicide rates among VHA patients remained the same. This study evaluated this finding by examining variability in staffing increases between VHA's 21 regional networks (Veterans Integrated Service Networks) (VISNs) and associations with suicide rates. Suicide rates among VHA patients were derived from the National Death Index and VHA clinical and administrative records for 2005 and 2009. Comparisons across VISNs used measures of proportional change in mental health staffing (overall and in inpatient, residential, intensive case management, and outpatient programs) and comparable measures of mental health staffing per 1,000 mental health patients. Significant correlations were found between proportional changes from 2005 to 2009 in suicide rates and outpatient mental health staffing (r=-.453, p=.039) and outpatient mental health staffing per 1,000 patients (r=-.533, p=.013). The ten VISNs above the median in proportional changes in mental health staffing had average decreases in suicide rates of 12.6% while those below had increases of 11.6% (p=.005). For proportional changes in mental health staffing per 1,000 patients, those above the median had decreases of 11.2% and those below had increases of 13.8% (p=.014). For the average VISN, it would have required a 27.5%-36.8% increase in outpatient staff over 2005 levels to decrease suicide rates by 10%. Mental health enhancements in VHA were associated with decreases in suicide rates in VISNs where the increases in mental health outpatient staffing were greatest.

  15. Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes

    PubMed Central

    Bowblis, John R

    2011-01-01

    Objective To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. PMID:21609329

  16. Staffing ratios and quality: an analysis of minimum direct care staffing requirements for nursing homes.

    PubMed

    Bowblis, John R

    2011-10-01

    To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. STUDY DESIGN; Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. © Health Research and Educational Trust.

  17. Using computer simulation for optimal staffing: A case for the patient registration process of a hospital.

    PubMed

    Shim, Sung J; Kumar, Arun; Jiao, Roger

    2017-01-01

    Some healthcare managers use computer simulation to assist with staffing. As staffing actions are usually slow to evolve and long term in nature, computer simulation can provide the opportunity to evaluate different alternatives at substantially lower costs with fewer risks. Using computer simulation, this paper seeks to determine the optimal number and allocation of clerks involved in the patient registration process of a hospital. This paper is based on a case study conducted in a hospital and uses historical data provided by the hospital in simulating the patient registration process. The simulation results indicate that computer simulation can be an effective decision supporting tool in modeling the patient registration process and evaluating the effects of changes in the number and allocation of clerks in the process. Based upon a case study applying real-world data, the results of this paper would be beneficial to those who consider utilizing computer simulation for staffing decisions.

  18. Effects of increasing nurse staffing on missed nursing care.

    PubMed

    Cho, S-H; Kim, Y-S; Yeon, K N; You, S-J; Lee, I D

    2015-06-01

    Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013. The study aims to compare missed nursing care (omission of required care) in high-staffing (7 patients per nurse) units vs. low-staffing (17 patients per nurse) units to examine the effects of nurse staffing on missed care. A nurse survey conducted in July 2013 targeted all staff nurses in all four high-staffing and all nine low-staffing units; 115 nurses in the high-staffing units (response rate = 94.3%) and 117 nurses in the low-staffing units (response rate = 88.6%) participated. Missed nursing care was measured using the MISSCARE survey that included 24 nursing care elements. Nurses were asked how frequently they had missed each element on a 4-point scale from 'rarely' to 'always'. Overall, nurses working in high-staffing units had a significantly lower mean score of missed care than those in low-staffing units. Seven out of 24 nursing care elements were missed significantly less often in high-staffing (vs. low-staffing) units: turning, mouth care, bathing/skin care, patient assessments in each shift, assistance with toileting, feeding and setting up meals. The findings suggest that increasing nurse staffing is associated with a decrease in missed care. Less omission of required nursing care is expected to improve nursing surveillance and patient outcomes, such as patient falls, pressure ulcers and pneumonia. Adequate nurse staffing should be ensured to reduce unmet nursing needs and improve patient outcomes. © 2015 International Council of Nurses.

  19. Nighttime Intensivist Staffing and Mortality among Critically Ill Patients

    PubMed Central

    Wallace, David J.; Angus, Derek C.; Barnato, Amber E.; Kramer, Andrew A.; Kahn, Jeremy M.

    2014-01-01

    BACKGROUND Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown. METHODS We conducted a retrospective cohort study involving ICUs that participated in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010, linking a survey of ICU staffing practices with patient-level outcomes data from adult ICU admissions. Multivariate models were used to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix. We conducted a confirmatory analysis in a second, population-based cohort of hospitals in Pennsylvania from which less detailed data were available. RESULTS The analysis with the use of the APACHE database included 65,752 patients admitted to 49 ICUs in 25 hospitals. In ICUs with low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for death, 0.62; P = 0.04). Among ICUs with high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect to risk-adjusted in-hospital mortality (odds ratio, 1.08; P = 0.78). In the verification cohort, there was a similar relationship among daytime staffing, nighttime staffing, and in-hospital mortality. The interaction between nighttime staffing and daytime staffing was not significant (P = 0.18), yet the direction of the findings were similar to those in the APACHE cohort. CONCLUSIONS The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing. (Funded by the

  20. Staffing of the Systems Development Life Cycle: An Empirical Study of Charitable Nonprofit Organizations.

    ERIC Educational Resources Information Center

    Pick, James B.

    1992-01-01

    Explains the Systems Development Life Cycle (SDLC) construct, which is used for development of management information systems, and analyzes the staffing composition of SDLC steps for nonprofit arts organizations including art museums and symphony orchestras. The use of outside help, in-house personnel, and volunteers is examined; and the influence…

  1. 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…

  2. 10 CFR 719.15 - What are the requirements for a staffing and resource plan?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false What are the requirements for a staffing and resource plan? 719.15 Section 719.15 Energy DEPARTMENT OF ENERGY CONTRACTOR LEGAL MANAGEMENT REQUIREMENTS Legal... such phases; (3) Projected cost for each phase of the representation; and (4) Numbers and mix...

  3. 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…

  4. 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…

  5. Organizing and Staffing Technology Leadership

    ERIC Educational Resources Information Center

    Mills, Lane B.

    2005-01-01

    The organization of technology leadership for school districts is as wide-ranging as the types of technology in our schools. And just as with different hardware and software applications, certain structures of leadership work better for some systems than others. Strong organization skills are needed to manage the myriad of dynamics involved in…

  6. Teaming, Staffing, and Improving Instruction.

    ERIC Educational Resources Information Center

    Harris, Ben M.

    Educational leaders' effective use of communications, collaboration, and common interests provides the key to managing a surplus of human resources. Students, like all members of an organization, are both a potential resource in fulfilling educational goals, and a personal and financial liability. Increases in the population, an aging citizenry,…

  7. 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.

  8. Impact of a financial incentive policy on Korean nurse staffing.

    PubMed

    Kim, Y; Kim, J

    2015-06-01

    This study was designed to determine (1) the impact of policy on longitudinal changes in nurse staffing levels and (2) the characteristics of policy-responsive Korean hospitals. A policy of varying nursing fees according to staffing grade by measuring the nurse-to-bed ratio has been implemented in Korean hospitals since 1999 with the aim of satisfying patient care needs and providing safe and high-quality nursing care. Nurse staffing hospital characteristics data were collected from Korean Hospital Nurses Association yearbooks for the period 1996-2011. The obtained time series nurse staffing data were analysed by assessing the nurse-to-bed ratio. Graphs were used to view nurse staffing trends in various nursing units by hospital type during the study period. Mixed repeated-measures modelling was used to analyse nurse staffing and hospital characteristics, with year categorized as a dummy variable. There were 585 and 1239 observations related to measurements of nurse staffing grade in 44 tertiary and 193 general hospitals, respectively. For measuring the nurse staffing grade in intensive care units, the number of observations for general hospitals was decreased to 1170. Long-term nurse staffing in general and intensive care units was improved post-policy compared with pre-policy in both tertiary and general hospitals. Nurse staffing was improved more in Seoul than in other areas and was significantly better for hospitals with more beds for both hospital types. Although the financial incentive policy implemented in Korea has had an overall positive result on nurse staffing, the effect was not assure in small-sized hospitals in rural area. A more refined method for calculating nurse staffing and increasing financial incentives relative to staffing grade is needed to improve hospital nurse staffing. © 2014 International Council of Nurses.

  9. 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.

  10. The impact of fluctuating relationships with the Canadian health care system on family management of otitis media with effusion.

    PubMed

    Wuest, J; Stern, P N

    1990-05-01

    The analysis of data from a grounded theory study of family interaction when a child has otitis media with effusion (OME) shows that these families are engaged in the process of learning to manage. Their relationship with the health care system, coupled with the effects of the disease on the child and the family lifestyle, has a powerful influence on how this process proceeds. In this paper, the authors discuss the impact of the family's relationship with the Canadian health care system on the development of management skills. Relationships with the health care system fluctuate forward and backward through entrusting, becoming disillusioned, learning the rules and negotiating, as families learn to manage the effects of the disease process on the child and the family. The family perspective of the quality and availability of health care at a time when health care systems throughout the world are under close scrutiny, adds to our understanding of consumer expectations. Some recommendations for improving current relationships between families and the health care system are made.

  11. Forecasting Staffing Requirements for Hazardous Waste Cleanup.

    DTIC Science & Technology

    1991-02-01

    cleaning up contaminated sites even if they followed practices that were legal at the time of disposal. CERCLA is commonly known as the " Superfund ...the Superfund law and unlike many other Federal environmental statutes, CERCLA did not delegate administration of the law to the states. Among the...8217 Superfund staffing requirements model based on statistical analysis of historic workload data. It is based on the assumption that the size and

  12. Effect of nurse staffing variation and hospital resource utilization.

    PubMed

    Kim, Yunmi; Kim, Seon-Ha; Ko, Young

    2016-12-01

    In this study, we examined the effect of variations in nurse staffing levels on the length of stay and medical expenses of patients who underwent hip or knee surgeries. A cross-sectional study was conducted using the National Health Insurance database and hospital surveys from 2010. Patient length of stay and medical expenses by nurse staffing level and skill mix were compared after adjusting for hospital and patient characteristics. Nurse staffing was measured based on staffing grade, the bed-to-registered nurse/nurse aid ratio, the bed-to-nursing personnel ratio, and the RN proportion. Generalized estimation models were used to analyze the associations. Decreased nurse staffing was consistently associated with increased length of stay, regardless of nurse staffing measures. The medical expenses associated with the lowest staffing level were approximately $US 1142.2 more than those associated with the highest staffing level. The study results suggest that maintaining a high nurse staffing level could be a cost-effective strategy for government and insurers, as well as for patients. We propose that policy makers implement more efficient nurse staffing strategies. © 2016 John Wiley & Sons Australia, Ltd.

  13. Correlates of Licensed and Unlicensed Nurse Staffing Levels on Inpatient Psychiatric Units.

    PubMed

    Staggs, Vincent S

    2015-01-01

    Nurse staffing on inpatient psychiatric units was examined using data from a national sample of 409 hospitals. Hospitals' nonpsychiatric unit staffing predicted psychiatric unit staffing, accounting for 15.2% and 6.8% of variability in licensed and unlicensed staffing, respectively. Licensed and unlicensed staffing on psychiatric units were inversely related. Of the non-California hospitals in the study, 70% had annual levels of psychiatric unit staffing exceeding California's mandated 1:6 licensed staffing ratio.

  14. 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.

  15. Development of a computerized patient classification and staffing system.

    PubMed

    Park, H A; Park, J H

    1997-01-01

    Korean health care agencies are trying to find ways to survive amid strong competition within the health care industry and pressure to open health care market from abroad. One way to survive is to improve health care quality at present or reduced expenditure. Nursing is the largest manpower in health care agencies and plays an important role in determining quality of care through direct interaction with patients., thus, nursing manpower management is an essential part of survival strategies. If the nursing department can adapt to dynamic changes in the health care environment in terms of quality and quantity of service needed, health care agencies' quality and efficient management will be achieved at the same time. A computerized prototype patient classification and nursing staffing system was developed using Microsoft Visual Basic 3.0. This system allows a user to use GUI(Graphic User Interface) with an icon and a mouse. By applying this computerized system to clinical practice, nursing managers will receive accurate information regarding nursing manpower management at nursing unit level as well as departmental levels. Then nursing managers can achieve effective nursing manpower management, which will improve nursing care by allocating more nursing staff time to direct patient care.

  16. 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.

  17. Planning and evaluating evidence-based perinatal nurse staffing.

    PubMed

    Bingham, Debra; Ruhl, Catherine

    2015-01-01

    Nurse staffing decisions are high-cost decisions. Having too few nurses may cause more mistakes or more episodes of missed care resulting in worse outcomes, increased pain, and additional suffering and health care costs. Having too many nurses increases health care costs. The Organizing Frameworks for Calculating Nurse Staffing and for Evaluating Nurse Staffing Decisions presented in this article build on the American Nurses' Association's principle-based staffing models and Donabedian's framework for evaluating the quality of health care. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  18. Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers.

    PubMed

    Deshields, Teresa; Kracen, Amanda; Nanna, Shannon; Kimbro, Lisa

    2016-02-01

    The National Comprehensive Cancer Network (NCCN) is comprised of 25 National Cancer Institute-designated cancer centers and arguably could thus set the standard for optimal psychosocial staffing for cancer centers; therefore, information was sought from NCCN Member Institutions about their current staffing for psychosocial services. These findings are put into perspective given the limited existing literature and consensus reports. The NCCN Best Practices Committee surveyed member institutions about their staffing for psychosocial services. The survey was administered electronically in the winter of 2012. The survey was completed by 20 cancer centers. Across institutions, case managers and mental health therapists, typically social workers, were utilized most frequently to provide psychosocial services (67% of full-time-equivalents (FTEs)), with other psychosocial professionals also represented but less consistently. Most psychosocial services are institutionally funded (ranging from 64 to 100%), although additional sources of support include fee for service and grant funding. Training of psychosocial providers is unevenly distributed across responding sites, ranging from 92% of institutions having training programs for psychiatrists to 36% having training programs for mental health therapists. There was variability among the institutions in terms of patient volume, psychosocial services provided, and psychosocial staff employed. As accreditation standards are implemented that provide impetus for psychosocial services in oncology, it is hoped that greater clarity will develop concerning staffing for psychosocial services and uptake of these services by patients with cancer. Copyright © 2015 John Wiley & Sons, Ltd.

  19. 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

  20. Nursing home quality, cost, staffing, and staff mix.

    PubMed

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

    2004-02-01

    The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing homes in Missouri and classified into resident outcome groups. Resident outcomes were measured by use of quality indicators derived from nursing home Minimum Data Set resident assessment data. Cost and staffing information were derived from Medicaid cost reports. Participant observation methods were used to describe the care delivery processes. In facilities with good resident outcomes, there are basics of care and processes surrounding each that staff consistently do: helping residents with ambulation, nutrition and hydration, and toileting and bowel regularity; preventing skin breakdown; and managing pain. The analysis revealed necessary organizational attributes that must be in place in order for those basics of care to be accomplished: consistent nursing and administrative leadership, the use of team and group processes, and an active quality improvement program. The only facility characteristic across the outcome groups that was significantly different was the number of licensed beds, with smaller facilities having better outcomes. No significant differences in costs, staffing, or staff mix were detected across the groups. A trend in higher total costs of 13.58 dollars per resident per day was detected in the poor-outcome group compared with the good-outcome group. For nursing homes to achieve good resident outcomes, they must have leadership that is willing to embrace quality improvement and group process and see that the basics of care delivery are done for residents. Good quality care may not cost more than poor quality care; there is some evidence that good quality care may cost less. Small facilities of 60 beds were more likely to have good

  1. The end of growth? Analysing NHS nurse staffing.

    PubMed

    Buchan, James; Seccombe, Ian

    2013-09-01

    To present an overview of UK National Health Service nurse staffing changes across the last 10 years. National Health Service funding is now being constrained as part of the overall measures to reduce UK public expenditure. This has implications for future staffing levels and deployment. Government and professional associations are disagreeing about the current extent of actual and likely National Health Service nurse staffing decline. The paper reviews 'official' data and evidence on National Health Service staffing to assess actual National Health Service nurse staffing trends in recent years, highlights the results of scenario modeling of future National Health Service nursing numbers and relates this to national policies on staffing. The available evidence now points to nurse staffing growth having tailed off and a likely pattern of overall decline in National Health Service nurse staffing is emerging. This is a policy concern in the UK, but also in many other countries. Whilst there has been a 'recession benefit' to the UK nursing labour market, this supply side boost cannot continue indefinitely. Any continued trend towards reduced intakes to training and reduced staffing levels will intensify the debate about the appropriate staffing levels and skills mix. We have seen significant National Health Service nurse staffing growth in the last 10 years, which is likely now to reverse. The real measure of the effectiveness of local and national National Health Service nursing workforce policy is not how many nurses are employed, it is that sufficient are deployed to provide safe care. © 2012 Blackwell Publishing Ltd.

  2. Nursing intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver vs. kidney transplant recipients.

    PubMed

    Andersen, Marit Helen; Lønning, Kjersti; Bjørnelv, Gudrun Maria Waaler; Fagerström, Lisbeth

    2016-09-01

    To compare nursing intensity and nurse staffing costs for liver transplant (LTx) vs. kidney transplant (KTx) patients through the use of the RAFAELA system (the OPCq instrument). High-quality patient care correlates with the correct allocation of nursing staff. Valid systems for obtaining data on nursing intensity, in relation to actual patient care needs, are needed to ensure correct staffing. A prospective, comparative study of 85 liver and 85 kidney transplant patients. Nursing intensity was calculated using the Oulu Patient Classification (OPCq) instrument. The cost per nursing intensity point was calculated by dividing annual total nursing wage costs with annual total nursing intensity points. The results showed significantly higher nursing intensity per day for liver transplant patients compared to kidney transplant patients. The length of stay was the most important variable in relation to nursing intensity points per day. The study demonstrated differences in nursing intensity and nurse staffing costs between the two patient groups. When defending nurse staffing decisions, it is essential that nurse managers have evidence-based knowledge of nursing intensity and nurse staffing costs. © 2016 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.

  3. 10 CFR 719.15 - What are the requirements for a staffing and resource plan?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... and resource plan as provided in this section. The contractor must then forward the staffing and... staffing and resource plan and forward it to Department counsel. (b) A staffing and resource plan is a plan...

  4. 22 CFR 62.72 - Staffing and support services.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 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....

  5. 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....

  6. 22 CFR 62.72 - Staffing and support services.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 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....

  7. 22 CFR 62.72 - Staffing and support services.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 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....

  8. 22 CFR 62.72 - Staffing and support services.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 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....

  9. Staffing Patterns and State Mental Health Manpower Development.

    ERIC Educational Resources Information Center

    McCullough, Paul M., Comp.; McPheeters, Harold L., Comp.

    This publication presents adaptations of four papers given at a workshop on Staffing and Manpower Development, sponsored by the Mental Health Manpower Development project of the Southern Regional Education Board. The introduction delineates four dimensions to be considered in describing staffing patterns (organization, utilization, type, and…

  10. Nurse staffing. Finding the right number and mix.

    PubMed

    Sanford, Kathleen D

    2010-09-01

    Dissatisfaction with staffing is the main reason nurses leave hospitals. Hospital-acquired conditions are higher in hospitals with lower RN hours per patient day. Finance and nursing need to collaborate to determine appropriate nurse staffing so units are not overstaffed or understaffed.

  11. Relationship of Nursing Home Staffing to Quality of Care

    PubMed Central

    Schnelle, John F; Simmons, Sandra F; Harrington, Charlene; Cadogan, Mary; Garcia, Emily; Bates-Jensen, Barbara M

    2004-01-01

    Objective To compare nursing homes (NHs) that report different staffing statistics on quality of care. Data Sources Staffing information generated by California NHs on state cost reports and during onsite interviews. Data independently collected by research staff describing quality of care related to 27 care processes. Study Design Two groups of NHs (n=21) that reported significantly different and stable staffing data from all data sources were compared on quality of care measures. Data Collection Direct observation, resident and staff interview, and chart abstraction methods. Principal Findings Staff in the highest staffed homes (n=6), according to state cost reports, reported significantly lower resident care loads during onsite interviews across day and evening shifts (7.6 residents per nurse aide [NA]) compared to the remaining homes that reported between 9 to 10 residents per NA (n=15). The highest-staffed homes performed significantly better on 13 of 16 care processes implemented by NAs compared to lower-staffed homes. Conclusion The highest-staffed NHs reported significantly lower resident care loads on all staffing reports and provided better care than all other homes. PMID:15032952

  12. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Special staffing payments. 9701.363... staffing payments. DHS will issue implementing directives regarding additional payments for employees serving in positions for which DHS is experiencing or anticipates significant recruitment and/or...

  13. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Special staffing payments. 9701.363... staffing payments. DHS will issue implementing directives regarding additional payments for employees serving in positions for which DHS is experiencing or anticipates significant recruitment and/or...

  14. 29 CFR 1952.363 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.363 Section 1952.363 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... reassessment of the staffing levels initially established in 1980 and proposed revised benchmarks of 7 safety...

  15. 45 CFR 303.20 - Minimum organizational and staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HEALTH AND HUMAN SERVICES STANDARDS FOR PROGRAM OPERATIONS § 303.20 Minimum organizational and staffing requirements. (a) The organizational structure of the IV-D agency (see § 302.12) provides for administration or... 45 Public Welfare 2 2010-10-01 2010-10-01 false Minimum organizational and staffing requirements...

  16. Beyond a Band-Aid Approach: An Internal Agency Solution to Nurse Staffing.

    PubMed

    Adams, Jewel; Kaplow, Roberta; Dominy, Janet; Stroud, Bridgett

    2015-01-01

    The Institute of Medicine (IOM) affirmed that the employment of temporary or per diem nurses augments risk to patient safety. The IOM recommends health care facilities avoid hiring nurses working from a temporary external agency. The IOM recognizes the need for health care facilities to have a plan in place for situations when confronted with short staffing, higher acuity, and increased patient census. Based on recommendations from the IOM, an internal agency was developed in a university-based health care system. Cost savings were realized because of the collaborative efforts of human resources to fill vacancies, unit management managing their respective budgets by flexing staff based on patient census, and the development and implementation of the Enterprise Staffing Pool.

  17. The relationship between nurse staffing and quality of care in nursing homes: a systematic review.

    PubMed

    Spilsbury, Karen; Hewitt, Catherine; Stirk, Lisa; Bowman, Clive

    2011-06-01

    Nursing homes have an important role in the provision of care for dependent older people. Ensuring quality of care for residents in these settings is the subject of ongoing international debates. Poor quality care has been associated with inadequate nurse staffing and poor skills mix. To review the evidence-base for the relationship between nursing home nurse staffing (proportion of RNs and support workers) and how this affects quality of care for nursing home residents and to explore methodological lessons for future international studies. A systematic mapping review of the literature. Published reports of studies of nurse staffing and quality in care homes. Systematic search of OVID databases. A total of 13,411 references were identified. References were screened to meet inclusion criteria. 80 papers were subjected to full scrutiny and checked for additional references (n=3). Of the 83 papers, 50 were included. Paper selection and data extraction completed by one reviewer and checked by another. Content analysis was used to synthesise the findings to provide a systematic technique for categorising data and summarising findings. A growing body of literature is examining the relationships between nurse staffing levels in nursing homes and quality of care provided to residents, but predominantly focuses on US nursing facilities. The studies present a wide range and varied mass of findings that use disparate methods for defining and measuring quality (42 measures of quality identified) and nurse staffing (52 ways of measuring staffing identified). A focus on numbers of nurses fails to address the influence of other staffing factors (e.g., turnover, agency staff use), training and experience of staff, and care organisation and management. 'Quality' is a difficult concept to capture directly and the measures used focus mainly on 'clinical' outcomes for residents. This systematic mapping review highlights important methodological lessons for future international studies

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

    PubMed Central

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

    2016-01-01

    Objectives 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. Setting 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. Primary and secondary outcomes To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. Results 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. Conclusions 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. PMID:27986733

  19. 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.

  20. Clinical staffing in staff- and group-model HMOs.

    PubMed

    Dial, T H; Palsbo, S E; Bergsten, C; Gabel, J R; Weiner, J

    1995-01-01

    Analysts frequently have used health maintenance organization (HMO) staffing patterns as a yardstick for estimating national clinical workforce requirements. Based on a nationwide survey of fifty-four staff- and group-model HMOs, the largest sample yet used in an analysis of this type, this DataWatch examines physician-to-member ratios, the use of nonphysician providers, and HMOs' methods of estimating clinical staffing needs. Overall physician staffing ratios and primary care physician staffing ratios closely resemble those reported in previous studies, but they exhibit wide variability and are strongly correlated with HMO size. Although caution should be exercised when using HMO staffing ratios in projections of physician workforce requirements, the ratios described here support projections of a specialty physician surplus.

  1. Defense Health Care: Additional Information Needed about Mental Health Provider Staffing Needs

    DTIC Science & Technology

    2015-01-01

    Members, and Military Families (Aug. 31, 2012). Page 2 GAO-15-184 DOD Mental Health Staffing of mental health providers.4 These...improve these services. See Executive Order 13625, Improving Access to Mental Health Services for Veterans, Service Members, and Military Families ...MHS. The DHA manages the execution of policies issued by OASD HA, oversees the TRICARE health plan, and also exercises authority and control over the

  2. An Evaluative Study of the Navy Medical Department’s Patient Classification System and Staffing Allocation.

    DTIC Science & Technology

    1984-08-01

    undertaken by the National - League of Nursing Education . These evolved from concern regarding the * appropriate tasks and numbers of patients assigned per...National League of Nursing Education ,198 p. 5.t. 5 5-,..- 5OTOTS"":’- *-. fo-.- 11. M. I. Cuthert, Planning for Nuree Staffing: A Bibliography on Patient...National League of Nursing Education , 1948. Hayes, N., and Moritz, M. "Patient Classification Systems - A Nurse Management Tool." Dimensions in Health

  3. California's Minimum Nurse Staffing Legislation: Results from a Natural Experiment

    PubMed Central

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

    2013-01-01

    Objective To determine whether, following implementation of California's minimum nurse staffing legislation, changes in acuity-adjusted nurse staffing and quality of care in California hospitals outpaced similar changes in hospitals in comparison states without such regulations. Data Sources/Study Setting Data from the American Hospital Association Annual Survey of Hospitals, the California Office of Statewide Health Planning and Development, the Hospital Cost Report Information System, and the Agency for Healthcare Research and Quality's Health Care Cost and Utilization Project's State Inpatient Databases from 2000 to 2006. Study Design We grouped hospitals into quartiles based on their preregulation staffing levels and used a difference-in-difference approach to compare changes in staffing and in quality of care in California hospitals to changes over the same time period in hospitals in 12 comparison states without minimum staffing legislation. Data Collection/Extraction Methods We merged data from the above data sources to obtain measures of nurse staffing and quality of care. We used Agency for Healthcare Research and Quality's Patient Safety Indicators to measure quality. Principal Findings With few exceptions, California hospitals increased nurse staffing levels over time significantly more than did comparison state hospitals. Failure to rescue decreased significantly more in some California hospitals, and infections due to medical care increased significantly more in some California hospitals than in comparison state hospitals. There were no statistically significant changes in either respiratory failure or postoperative sepsis. Conclusions Following implementation of California's minimum nurse staffing legislation, nurse staffing in California increased significantly more than it did in comparison states' hospitals, but the extent of the increases depended upon preregulation staffing levels; there were mixed effects on quality. PMID:22998231

  4. 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

    ... Link Staffing, Forge Staffing, Career Transitions and Talent Source; South Bend, Indiana; Amended... information from the company shows that workers leased from Career Transitions and Talent Source were employed... findings, the Department is amending this certification to include workers leased from Career...

  5. Thermal biology, population fluctuations and implications of temperature extremes for the management of two globally significant insect pests.

    PubMed

    Nyamukondiwa, Casper; Weldon, Christopher W; Chown, Steven L; le Roux, Peter C; Terblanche, John S

    2013-12-01

    The link between environmental temperature, physiological processes and population fluctuations is a significant aspect of insect pest management. Here, we explore how thermal biology affects the population abundance of two globally significant pest fruit fly species, Ceratitis capitata (medfly) and C. rosa (Natal fruit fly), including irradiated individuals and those expressing a temperature sensitive lethal (tsl) mutation that are used in the sterile insect technique. Results show that upper and lower lethal temperatures are seldom encountered at the field sites, while critical minimum temperatures for activity and lower developmental thresholds are crossed more frequently. Estimates of abundance revealed that C. capitata are active year-round, but abundance declines markedly during winter. Temporal autocorrelation of average fortnightly trap captures and of development time, estimated from an integrated model to calculate available degree days, show similar seasonal lags suggesting that population increases in early spring occur after sufficient degree-days have accumulated. By contrast, population collapses coincide tightly with increasing frequency of low temperature events that fall below critical minimum temperatures for activity. Individuals of C. capitata expressing the tsl mutation show greater critical thermal maxima and greater longevity under field conditions than reference individuals. Taken together, this evidence suggests that low temperatures limit populations in the Western Cape, South Africa and likely do so elsewhere. Increasing temperature extremes and warming climates generally may extend the season over which these species are active, and could increase abundance. The sterile insect technique may prove profitable as climates change given that laboratory-reared tsl flies have an advantage under warmer conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Unequal staffing: A snapshot of nurse staffing in critical care units in New South Wales, Australia.

    PubMed

    Harding, Thomas; Wright, Michael

    2014-01-01

    Abstract A growing body of research provides evidence of the link between nurse-to-patient ratios (NTPRs) and skill mix with adverse patient outcomes. This paper reports an investigation into nurse staffing patterns, skill mix and patient movement in critical care units in NSW, Australia. A 'snapshot' of staffing patterns and patient movement over 1 week in October 2012 was obtained by use of a cross-sectional design using retrospective survey and administrative data. A wide variation was found in NTPRs, skill mix and the number of nursing staff vacancies in coronary care and high dependency units. These variations suggest that the quality of patient care may vary between facilities in New South Wales.

  7. Unequal staffing: A snapshot of nurse staffing in critical care units in New South Wales, Australia.

    PubMed

    Harding, Thomas; Wright, Michael

    2014-02-03

    Abstract A growing body of research provides evidence of the link between nurse-to-patient ratios and skill mix with adverse patient outcomes. This paper reports an investigation into nurse staffing patterns, skill mix and patient movement in critical care units in New South Wales, Australia. A 'snapshot' of staffing patterns and patient movement over one week in October 2012 was obtained by use of a cross-sectional design using retrospective survey and administrative data. A wide variation was found in nurse-to-patient ratios, skill mix and the number of nursing staff vacancies in coronary care and high dependency units. These variations suggest that the quality of patient care may vary between facilities in New South Wales.

  8. Cost Effective Staffing for an EHR Implementation.

    PubMed

    Bullard, Katherine L

    2016-01-01

    This case study explores costs of electronic health record (EHR) implementation with the nursing super-user role in a metropolitan, not-for-profit health care system. Tapping the local pool of unemployed newly graduated nurses as half the required super-user workforce leveraged the technology skills of novice registered nurses (RNs) as trainers of experienced nurses in five hospitals. The novel workforce migrated from hospital to hospital, thereby reducing the number of experienced nurses reassigned to super-user duties in each hospital. This strategy reduced the amount of contract labor required to backfill nurse super-users' clinical shifts. Employment of the recently graduated nurses as RN residents upon completion of the EHR implementation enabled the organization to augment its clinical workforce with expert users of its EHR. The proposed innovative model increases super-users, minimizes disruption of core staffing, and dramatically reduces expense.

  9. Quality Outcomes of Hospital Supplemental Nurse Staffing

    PubMed Central

    Xue, Ying; Aiken, Linda H.; Freund, Deborah A.; Noyes, Katia

    2017-01-01

    Background Use of supplemental registered nurses (SRNs) is common practice among U.S. hospitals to fill gaps in nurse staffing. Objective To examine the relationship between use of SRNs and patient outcomes. Methods Multilevel modeling was performed to analyze hospital administrative data from 19 hospital units in a large tertiary medical center for the years 2003–2006. Patient outcomes included in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses. Results SRN use ranged from 0–30.4% of total RN hours per unit quarter. Among 188 of the 304 unit quarters in which SRNs were used, the average SRN use was 9.8% in non-ICUs and 6.4% in ICUs. All observed effects of SRN use on patient outcomes were non-significant. Conclusions SRN use was substantial and varied widely by unit. No evidence was found that links SRN use to either adverse or positive patient outcomes. PMID:23151931

  10. Staffing and Training Requirements for Electronic Text Production. Report Number Seven of the Electronic Text Report Series.

    ERIC Educational Resources Information Center

    Carey, John; Enerson, Meryl

    Based on the responses to a survey sent to 23 electronic text managers, this report provides information on the staffing and training requirements associated with the production of electronic text materials. It is directed primarily towards those in higher education and the nonprofit community, including local colleges, public television stations,…

  11. 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

  12. 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.

  13. 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.

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

    PubMed

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

    2014-05-01

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

  15. Technical basis for staffing levels at nuclear power plants

    SciTech Connect

    Shurberg, D.A.; Haber, S.B.; Morisseau, D.

    1995-04-01

    The objective of this project is to provide a technical basis for the establishment of criteria for minimum staffing levels of licensed and non-licensed NPP shift personnel. Minimum staffing levels for the purpose of this study, are defined as those necessary for successful accomplishment of all safety and additional functions that must be performed in order for the licensee to meet applicable regulatory requirements. This project involves a multi-faceted approach to the investigation of the issue. Relevant NRC documentation was identified and reviewed. Using the information obtained from this documentation review, a test plan was developed to aid in the collection of further information regarding the adequacy of current shift staffing levels. The test plan addresses three different activities to be conducted to provide information to the NRC for use in the assessment of current minimum staffing levels. The first activity is collection of data related to industry shift staffing practices through site visits to seven nuclear power plants. The second activity is a simulator study, which will use licensed operator crews responding to a simulated event, under two different staffing levels. Finally, workload models will be constructed for both licensed and non-licensed personnel, using a priori knowledge of the simulator scenarios with data resulting from one of the staffing levels studied in the simulator, and the data collected from the site visits. The model will then be validated against the data obtained from the second staffing level studied in the simulator. The validated model can then be used to study the impact of changing staffing-related variables on the plant shift crew`s ability to effectively mitigate an event.

  16. Modeling access, cost, and perceived quality: computer simulation benefits orthodontic clinic staffing decisions.

    PubMed

    Montgomery, J B; LaFrancois, G G; Perry, M J

    2000-02-01

    Given limited financial resources, simulation permits a financial analysis of the optimum staffing levels for orthodontists and dental assistants in an orthodontic clinic. A computer simulation provides the information for managerial review. This study, by building a computer simulation of an orthodontic service, set out to determine the most efficient mix between providers and support staff to maximize access, maximize perceived quality, and minimize expenditures. Six combinations of providers and support staff were compared during an animated, computer-generated what-if analysis. Based on the clinic workload and size, on the cost per patient, and on the cost per quality point, the research team recommended a staffing mix of one orthodontist and three assistants. This study shows that computer simulation is an enormous asset as a decision support tool for management.

  17. Nurse staffing and the relationship to job satisfaction and retention.

    PubMed

    Hairr, Debra C; Salisbury, Helen; Johannsson, Mark; Redfern-Vance, Nancy

    2014-01-01

    The purpose of this quantitative, correlational research study was to examine the relationships between nurse staffing, job satisfaction, and nurse retention in an acute care hospital environment. Results indicated a moderately strong, inverse relationship between job satisfaction and nurse retention. A weak positive relationship between job satisfaction and nurse staffing was identified. Nurses reported experiencing job dissatisfaction in the past 6 months specifically related to the number of patients assigned. Analysis suggested nurses are staying with their current employer because of the current economic environment. Improving nurse staffing will be necessary when the economy improves to prevent the departure of discontented nurses from acute care facilities.

  18. 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

  19. Nurse staffing and patient outcomes in inpatient rehabilitation settings.

    PubMed

    Nelson, Audrey; Powell-Cope, Gail; Palacios, Polly; Luther, Stephen L; Black, Terrie; Hillman, Troy; Christiansen, Beth; Nathenson, Paul; Gross, Jan Coleman

    2007-01-01

    In rehabilitation nursing, the patient classification systems or acuity models and nurse-staffing ratios are not supported by empirical evidence. Moreover there are no studies published characterizing nursing hours per patient day, proportion of RN staff and impact of agency nurses in inpatient rehabilitation settings. The purpose of this prospective observational study was to describe rehabilitation nurse staffing patterns, to validate the impact of rehabilitation nursing on patient outcomes, and to test whether existing patient measures on severity and outcomes in rehabilitation could be used as a proxy for burden of care to predict rehabilitation nurse staffing ceilings and daily nurse staffing requirements. A total of 54 rehabilitation facilities in the United States, stratified by geography, were randomly selected to participate in the study.

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

    PubMed

    McHugh, Matthew D; Ma, Chenjuan

    2014-01-01

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

  1. Fluctuation phenomena

    SciTech Connect

    Montroll, E.W.; Lebowitz, J.L.

    1986-01-01

    Fluctuation phenomena are the ''tip of the iceberg'' revealing the existence, behind even the most quiescent appearing macroscopic states, of an underlying world of agitated, ever-changing microscopic processes. While the presence of these fluctuations can be ignored in some cases, e.g. if one is satisfied with purely thermostatic description of systems in equilibrium, they are central to the understanding of other phenomena, e.g. the nucleation of a new phase following the quenching of a system into the co-existence region. This volume contains a collection of review articles, written by experts in the field, on the subject of fluctuation phenomena. Some of the articles are of a very general nature discussing the modern mathematical formulation of the problems involved, while other articles deal with specific topics such as kinetics of phase transitions and conductivity in solids. The juxtaposition of the variety of physical situations in which fluctuation phenomena play an important role is novel and should give the reader an insight into this subject.

  2. 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

  3. Managerial implications of calculating optimum nurse staffing in medical units.

    PubMed

    Bordoloi, S K; Weatherby, E J

    1999-01-01

    A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, Alaska. We also indicate several managerial implications on how our results and their sensitivity analyses can be used effectively in decision making in a variety of categories.

  4. How the Fair Labor Standards Act affects your staffing.

    PubMed

    Bernreuter, M E

    1994-03-01

    The Fair Labor Standards Act allows exemption of professionals from overtime pay. However, this is often disregarded, and professional staff are compensated as nonexempt employees. The workweek definition then assumes increased importance as it may be a determining factor in the cost and availability of staff. This article discusses how altering the workweek may improve staffing. Various schedules are exhibited, and staffing and overtime pay implications of each are discussed.

  5. Staffing implications of software productivity models

    NASA Technical Reports Server (NTRS)

    Tausworthe, R. C.

    1983-01-01

    The attributes of software project staffing and productivity implied by equating the effects of two popular software models in a small neighborhood of a given effort-duration point are investigated. The first model presupposes that organizational productivity decreases as a function of the project staff size due to interfacing and intercommunication. The second, the so-called software equation, relates the product size to effort and duration through a power law tradeoff formula. The conclusions that may be reached by assuming that both of these describe project behavior, the former as a global phenomenon and the latter as a localized effect in a small neighborhood of a given effort duration point, are that (1) there is a calculable maximum effective staff level, which, if exceeded, reduces the project production rate, (2) there is a calculable maximum extent to which effort and time may be traded effectively, (3) it becomes ineffective in a practical sense to expend more than an additional 25 to 50% of resources in order to reduce delivery time, and (4) the team production efficiency can be computed directly from the staff level, the slope of the intercommunication loss function, and the ratio of exponents in the software equation.

  6. The relationship between nurse staffing and inpatient complications.

    PubMed

    Schreuders, Louise Winton; Bremner, Alexandra P; Geelhoed, Elizabeth; Finn, Judith

    2015-04-01

    To compare characteristics of hospitalizations with and without complications and examine the impact of nurse staffing on inpatient complications across different unit types. Studies investigating the relationship between nurse staffing and inpatient complications have not shown consistent results. Methodological limitations have been cited as the basis for this lack of uniformity. Our study was designed to address some of these limitations. Retrospective longitudinal hospitalization-level study. Adult hospitalizations to high intensity, general medical and general surgical units at three metropolitan tertiary hospitals were included. Data were sourced from Western Australian Department of Health administrative data collections from 2004-2008. We estimated the impact of nurse staffing on inpatient complications adjusted for patient and hospital characteristics and accounted for patients with multiple hospitalizations. The study included 256,984 hospitalizations across 58 inpatient units. Hospitalizations with complications had significantly different demographic characteristics compared with those without. The direction of the association between nurse staffing and inpatient complications was not consistent for different inpatient complications, nurse skill mix groups or for hospitalizations with different unit movement patterns. Our study design addressed limitations noted in the field, but our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates. Despite a strong international focus on improving nurse staffing to reduce inpatient complications, our results suggest that adding more nurses is not a panacea for reducing inpatient complications to zero. © 2014 John Wiley & Sons Ltd.

  7. Avoiding crisis: right-sizing staffing for the future.

    PubMed

    Best, Michele L

    2002-01-01

    Workforce issues, especially recruitment and retention of qualified laboratory staff, are major strategic issues that will continue to face laboratory managers over the next 10 years. Major factors affecting the laboratory labor market in the next decade include increased health-care and laboratory testing needs of an aging population, the graying of the laboratory workforce as baby boomers retire, and new technology development. At least two of these factors will increase the demand for qualified laboratory professionals. Vacancy rates for laboratory professionals are increasing at a significant rate and will continue over the next 10 years. Planning will require creativity in staff recruitment and retention strategies and in human resources. Laboratorians no longer will have the luxury of using medical technologists for nonspecialized testing assignments and will need to develop more creative recruiting approaches using fewer highly qualified testing personnel. This article proposes a staffing deployment model that will use medical technologist education and skills more appropriately, will improve retention of medical technologists, and will alleviate the shortage of medical technologists by reducing dependence on them as routine laboratory testing personnel.

  8. Predicting nurse staffing needs for a labor and birth unit in a large-volume perinatal service.

    PubMed

    Simpson, Kathleen Rice

    2015-01-01

    This project was designed to test a nurse staffing model for its ability to accurately determine staffing needs for a large-volume labor and birth unit based on a staffing gap analysis using the nurse staffing guidelines from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). The staffing model and the AWHONN staffing guidelines were found to be reliable methods to predict staffing needs for a large-volume labor and birth unit.

  9. [Relationship between nurse staffing and nursing outcomes: a narrative review of literature].

    PubMed

    Petrucci, Cristina; Calandro, Maria Teresa; Tresulti, Federica; Baldacchini, Antonio; Lancia, Loreto

    2015-01-01

    The measurement of nursing sensitive outcomes represents a fundamental element in "Health Management" in order to assess the suitability and quality of care given, particoulaly in hospitals for the acutely ill. To highlight how some variables connected with nurse-staffing can determine the quality of processes and the care outcomes. A narrative review of international literature has been carried out on investigating possible correlation between nurse-staffing characteristics and care outcomes regarding patients, taking into account primary and secondary sources, written either in English or Italian, without time limits. The bibliographical research strategies used, have brought about the restitution of no. 4244 articles were retrived, of these 56 were analyzed. Articles were categorized into 3 specific areas: 1) Which aspects determine the efficacy and quality of nursing care; 2) The direct effects of nursing care on care outcomes; 3) The indirect effects of nursing care on care outcomes. Results confirm the existence of a noticeable relationship between the main components of nurse-staffing and the direct and indirect outcomes on patients health. Longitudinal studies shound be carried out highlighting the results obtained up till now even more and assist in accurately measuring the importance of possible predictive variables on care outcomes correlated to nursing care.

  10. Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses.

    PubMed

    Hinno, Saima; Partanen, Pirjo; Vehviläinen-Julkunen, Katri

    2012-06-01

    To investigate the relationships between nursing activities, nurse staffing and adverse patient outcomes in hospital settings as perceived by registered nurses in Finland and the Netherlands and to compare the results obtained in the two countries. Previous research indicates that a higher proportion of registered nurses in the staff mix results in better patient outcomes. Knowledge of the relationship between nurse staffing and adverse patient outcomes is crucial to optimise the management of professional nursing resources and patient care. A cross-sectional, descriptive questionnaire survey. Registered nurses employed in hospitals in Finland (n = 535) and the Netherlands (n = 334), with overall response rates of 44·9% and 33·4%, respectively, participated. The patient-to-nurse ratio was on average 8·74:1 and did not vary significantly between the countries. However, there were fewer registered nurses and significantly more licensed practical nurses among the Dutch hospital staff than the Finnish staff. In addition, Finnish nurses performed non-nursing and administrative activities more frequently than the Dutch nurses and reported more dissatisfaction with the availability of support services. Frequencies of patient falls were related to the patient-to-nurse ratio in both countries. Finnish participants reported the occurrence of adverse patient outcomes more frequently. Significant associations were found between nurse staffing and adverse patient outcomes in hospital settings. Compared with the Netherlands, in Finland, nurses appear to have higher workloads, there are higher patient-to-nurse ratios, and these adverse staffing conditions are associated with higher rates of adverse patient outcomes. The findings provide valuable insights into the potential effects of major changes or reductions in nursing staff on the occurrence of adverse patient outcomes in hospital settings. © 2011 Blackwell Publishing Ltd.

  11. 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.

  12. Can mercury in fish be reduced by water level management? Evaluating the effects of water level fluctuation on mercury accumulation in yellow perch (Perca flavescens)

    USGS Publications Warehouse

    Larson, James H.; Maki, Ryan P.; Knights, Brent C.; Gray, Brian R.

    2014-01-01

    Mercury (Hg) contamination of fisheries is a major concern for resource managers of many temperate lakes. Anthropogenic Hg contamination is largely derived from atmospheric deposition within a lake’s watershed, but its incorporation into the food web is facilitated by bacterial activity in sediments. Temporal variation in Hg content of fish (young-of-year yellow perch) in the regulated lakes of the Rainy–Namakan complex (on the border of the United States and Canada) has been linked to water level (WL) fluctuations, presumably through variation in sediment inundation. As a result, Hg contamination of fish has been linked to international regulations of WL fluctuation. Here we assess the relationship between WL fluctuations and fish Hg content using a 10-year dataset covering six lakes. Within-year WL rise did not appear in strongly supported models of fish Hg, but year-to-year variation in maximum water levels (∆maxWL) was positively associated with fish Hg content. This WL effect varied in magnitude among lakes: In Crane Lake, a 1 m increase in ∆maxWL from the previous year was associated with a 108 ng increase in fish Hg content (per gram wet weight), while the same WL change in Kabetogama was associated with only a 5 ng increase in fish Hg content. In half the lakes sampled here, effect sizes could not be distinguished from zero. Given the persistent and wide-ranging extent of Hg contamination and the large number of regulated waterways, future research is needed to identify the conditions in which WL fluctuations influence fish Hg content.

  13. Can mercury in fish be reduced by water level management? Evaluating the effects of water level fluctuation on mercury accumulation in yellow perch (Perca flavescens).

    PubMed

    Larson, James H; Maki, Ryan P; Knights, Brent C; Gray, Brian R

    2014-10-01

    Mercury (Hg) contamination of fisheries is a major concern for resource managers of many temperate lakes. Anthropogenic Hg contamination is largely derived from atmospheric deposition within a lake's watershed, but its incorporation into the food web is facilitated by bacterial activity in sediments. Temporal variation in Hg content of fish (young-of-year yellow perch) in the regulated lakes of the Rainy-Namakan complex (on the border of the United States and Canada) has been linked to water level (WL) fluctuations, presumably through variation in sediment inundation. As a result, Hg contamination of fish has been linked to international regulations of WL fluctuation. Here we assess the relationship between WL fluctuations and fish Hg content using a 10-year dataset covering six lakes. Within-year WL rise did not appear in strongly supported models of fish Hg, but year-to-year variation in maximum water levels (∆maxWL) was positively associated with fish Hg content. This WL effect varied in magnitude among lakes: In Crane Lake, a 1 m increase in ∆maxWL from the previous year was associated with a 108 ng increase in fish Hg content (per gram wet weight), while the same WL change in Kabetogama was associated with only a 5 ng increase in fish Hg content. In half the lakes sampled here, effect sizes could not be distinguished from zero. Given the persistent and wide-ranging extent of Hg contamination and the large number of regulated waterways, future research is needed to identify the conditions in which WL fluctuations influence fish Hg content.

  14. Supplementing Intensivist Staffing With Nurse Practitioners: Literature Review.

    PubMed

    White, Tracie; Kokiousis, Justin; Ensminger, Stephanie; Shirey, Maria

    2017-01-01

    In the United States, providing health care to critically ill patients is a challenge. An increase in patients older than 65 years, a decrease in critical care physicians, and a decrease in work hours for residents cause intensivist staffing issues. In this article, use of nurse practictioners to fill the intensive care unit intensivist staffing gap is assessed and evidence-based recommendations are identified to better incorporate nurse practitioners as part of intensive care unit intensivist staffing. The literature reveals that when nurse practitioners are part of a staffing model, outcomes are either positively impacted or no different from physician outcomes. However, successfully integrating nurse practitioners into an intensive care unit team is not adequately discussed in the literature. This gap is addressed and 3 mechanisms to integrate nurse practitioners into the intensive care unit are identified: (1) use of a multidisciplinary staffing model, (2) completion of onboarding programs, and (3) evaluation of nurse practitioner productivity. ©2017 American Association of Critical-Care Nurses.

  15. Nurse Staffing Levels and Medicaid Reimbursement Rates in Nursing Facilities

    PubMed Central

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

    2007-01-01

    Objective To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates. Data Sources Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources. Study Design Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix. Principal Findings RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors. Conclusions To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours. PMID:17489906

  16. Long term fluctuations of groundwater mine pollution in a sulfide mining district with dry Mediterranean climate: Implications for water resources management and remediation.

    PubMed

    Caraballo, Manuel A; Macías, Francisco; Nieto, José Miguel; Ayora, Carlos

    2016-01-01

    Water resources management and restoration strategies, and subsequently ecological and human life quality, are highly influenced by the presence of short and long term cycles affecting the intensity of a targeted pollution. On this respect, a typical acid mine drainage (AMD) groundwater from a sulfide mining district with dry Mediterranean climate (Iberian Pyrite Belt, SW Spain) was studied to unravel the effect of long term weather changes in water flow rate and metal pollutants concentration. Three well differentiated polluting stages were observed and the specific geochemical, mineralogical and hydrological processes involved (pyrite and enclosing rocks dissolution, evaporitic salts precipitation-redisolution and pluviometric long term fluctuations) were discussed. Evidencing the importance of including longer background monitoring stage in AMD management and restoration strategies, the present study strongly advise a minimum 5-years period of AMD continuous monitoring previous to the design of any AMD remediation system in regions with dry Mediterranean climate. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. 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.

  18. 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

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

    PubMed Central

    Foster, Andrew D.; Lee, Yong Suk

    2015-01-01

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

  20. Determining medical staffing requirements for humanitarian assistance missions.

    PubMed

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

    2010-01-01

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

  1. Nurse staffing and patient outcomes in Belgian acute hospitals

    PubMed Central

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

    2008-01-01

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

  2. 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.

  3. Off-peak nurse staffing: critical-care nurses speak.

    PubMed

    Eschiti, Valerie; Hamilton, Patti

    2011-01-01

    The off-peak work environment is important to understand because the risk for mortality increases for patients at night and on the weekend in hospitals. Because critical-care nurses are on duty in hospitals 24 hours a day, 7 days a week, they are excellent sources of information regarding what happens on a unit during off-peak times. Inadequate nurse staffing on off-peak shifts was described as a major problem by the nurses we interviewed. The study reported here contributes the type of information needed to better understand the organization of nursing units and nurse staffing on outcomes.

  4. Scaling Properties of Biologically Active Scalar Concentration Fluctuations in the Atmospheric Surface Layer over a Managed Peatland

    NASA Astrophysics Data System (ADS)

    Detto, Matteo; Baldocchi, Dennis; Katul, Gabriel G.

    2010-09-01

    The higher-order scalar concentration fluctuation properties are examined in the context of Monin-Obukhov similarity theory for a variety of greenhouse gases that have distinct and separate source/sink locations along an otherwise ideal micrometeorological field site. Air temperature and concentrations of water vapour, carbon dioxide and methane were measured at high frequency (10 Hz) above a flat and extensive peat-land soil in the San Joaquin-Sacramento Delta (California, USA) area, subjected to year-round grazing by beef cattle. Because of the heterogeneous distribution of the sources and sinks of CO2 and especially CH4 emitted by cattle, the scaling behaviour of the higher-order statistical properties diverged from predictions based on a balance between their production and dissipation rate terms, which can obtained for temperature and H2O during stationary conditions. We identify and label these departures as ‘exogenous’ because they depend on heterogeneities and non-stationarities induced by boundary conditions on the flow. Spectral analysis revealed that the exogenous effects show their signatures in regions with frequencies lower than those associated with scalar vertical transport by turbulence, though the two regions may partially overlap in some cases. Cospectra of vertical fluxes appear less influenced by these exogenous effects because of the modulating role of the vertical velocity at low frequencies. Finally, under certain conditions, the presence of such exogenous factors in higher-order scalar fluctuation statistics may be ‘fingerprinted’ by a large storage term in the mean scalar budget.

  5. [Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics].

    PubMed

    Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A

    2001-01-01

    Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

  6. 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.

  7. Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative

    PubMed Central

    Peikes, Deborah N.; Reid, Robert J.; Day, Timothy J.; Cornwell, Derekh D. F.; Dale, Stacy B.; Baron, Richard J.; Brown, Randall S.; Shapiro, Rachel J.

    2014-01-01

    PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODS We undertook a descriptive analysis of CPC initiative practices’ baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis. RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators—all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician. CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost. PMID:24615310

  8. Nursing staff fluctuation and pathogenic burden in the NICU - effective outbreak management and the underestimated relevance of non-resistant strains

    PubMed Central

    Hensel, Kai O.; van den Bruck, Rhea; Klare, Ingo; Heldmann, Michael; Ghebremedhin, Beniam; Jenke, Andreas C.

    2017-01-01

    In the course of a hospital management takeover, a microbial outbreak took place in a tertiary neonatal intensive care unit (NICU). Here, we characterize the outbreak and its management. About 4 months prior to takeover, there was a sharp increase in positive isolates for MSSA and multidrug-resistant organisms (MDROs). Simultaneously, the nursing staff sick leave rate increased dramatically which directly correlated with the number of infection/colonization per week (r2 = 0.95, p = 0.02). During the following months we observed several peaks in positive isolates of methicillin-sensitive staphylococcus aureus (MSSA), MDROs and subsequently a vancomycin-resistant enterococcus (VRE) outbreak. Interventional outbreak management measures were only successful after substantial recruitment of additional nursing staff. None of the VRE, but 44% (n = 4) of MDRO and 32% (n = 23) of MSSA colonized infants developed symptomatic infections (p = 0.02). Among the latter, 35% suffered from serious consequences such as osteomyelitis. The most important risk factors for colonization-to-infection progression were low gestational age and birth weight. Nursing staff fluctuation poses a substantial risk for both bacterial colonization and infection in neonates. Comprehensive outbreak management measures are only successful if adequate nursing staff is available. Non resistant strains account for most neonatal infections – possibly due to their limited perception as being harmful. PMID:28322345

  9. Comparing the nurse staffing in Korean and U.S. nursing homes.

    PubMed

    Lee, Hyang Yuol; Shin, Juh Hyun; Harrington, Charlene

    2015-01-01

    The quality of nursing home care has been problematic in both the United States and South Korea; quality is limited to inadequate nurse staffing levels. This article addresses how South Korean nursing home education and training requirements, nurse staffing standards, and actual nurse staffing levels compare with those in the United States. The study used secondary documents and data to compare the two countries. Korea has lower registered nurse and certified nursing assistant standards and actual staffing levels than the United States. In contrast, staffing standards and actual staffing levels for care workers who provide direct care to residents are higher in Korea than in the United States. Research is needed in Korea to establish an empirical basis for educational requirements, staffing standards, and staffing levels in nursing homes. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Minister didn't say government won't support safe staffing bill.

    PubMed

    Clark, June

    2015-03-25

    I am afraid your report on the progress of the safe nurse staffing levels bill, 'Minimum staffing ratios failed to gain Welsh Government support' (News March 11) may give an unnecessarily pessimistic picture of the situation.

  11. 42 CFR 432.50 - FFP: Staffing and training costs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Staffing and Training Expenditures... specified areas for which the higher rate is authorized. (3) The allocation of personnel and staff costs...) For skilled professional medical personnel and directly supporting staff of the Medicaid agency or...

  12. 42 CFR 432.50 - FFP: Staffing and training costs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE PERSONNEL ADMINISTRATION Staffing and Training Expenditures... specified areas for which the higher rate is authorized. (3) The allocation of personnel and staff costs...) For skilled professional medical personnel and directly supporting staff of the Medicaid agency or...

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

    ERIC Educational Resources Information Center

    Sergean, R.

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

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

    PubMed

    Munnich, Elizabeth L

    2014-08-01

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

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

    ERIC Educational Resources Information Center

    Lovely, Suzette

    2004-01-01

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

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

    ERIC Educational Resources Information Center

    Keigher, Sharon M.

    1993-01-01

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

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

    PubMed

    Warren, Bryan

    2013-01-01

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

  18. 42 CFR 483.430 - Condition of participation: Facility staffing.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Disabilities § 483.430 Condition of participation: Facility staffing. (a) Standard: Qualified intellectual... by a qualified intellectual disability professional who— (1) Has at least one year of experience working directly with persons with intellectual disability or other developmental disabilities; and (2)...

  19. 42 CFR 483.430 - Condition of participation: Facility staffing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Disabilities § 483.430 Condition of participation: Facility staffing. (a) Standard: Qualified intellectual... by a qualified intellectual disability professional who— (1) Has at least one year of experience working directly with persons with intellectual disability or other developmental disabilities; and (2)...

  20. 42 CFR 483.430 - Condition of participation: Facility staffing.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Disabilities § 483.430 Condition of participation: Facility staffing. (a) Standard: Qualified intellectual... by a qualified intellectual disability professional who— (1) Has at least one year of experience working directly with persons with intellectual disability or other developmental disabilities; and (2)...

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

    ERIC Educational Resources Information Center

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

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

  2. Nurse Staffing Methodology, A Review and Critique of Selected Literature.

    ERIC Educational Resources Information Center

    Aydelotte, Myrtle K.

    In recent years much has been written on the subject of nurse staffing but few attempts have been made to integrate the literature and show relationships between the methodologies. This document is an effort to synthesize and critically examine the major methodological research studies in the field of nursing. Included are: (1) a bibliography of…

  3. Diagnosis Related Groups as Indicators of Nurse Staffing Requirements

    DTIC Science & Technology

    1985-07-01

    Conceptual Equation ............................ ............ 6 2. Revised Conceptual Equation .. ................................ 34 LIST OF TABLES...involving intra-hospital variable itaffing have been developed in the last twenty 11 years. These staffing systems are based on the intencity or amount of... equation to represent this concept (See Figure 1). The frequency of each DRG in the -ease mix would be evaluated and adjusted for any anticipated changes

  4. Forecasting staffing requirements for hazardous-waste cleanup. Final report

    SciTech Connect

    Salthouse, R.W.

    1991-02-01

    This report addresses a need to be able to forecast the staffing levels required to supervise cleanups of hazardous waste sites in support of the U.S. Environmental Protection Agency. A Civil Works' Superfund staffing requirements model based on statistical analysis of historic workload data. It is based on the assumption that the size and complexity of future programs will be related to the size and complexity of past programs. A wide variety of factors affect staffing levels, but it was found that the two most important ones are total cost and project type or complexity. The three types of work used in the model are remedial design, supervision of remedial construction, and additional technical assistance to the Environmental Protection Agency. Historical data was used to determine the relationship between dollars spent and man hours expended for various types of work: the distribution of project sizes, durations, and start dates; and the functional relationship between time spent and work accomplished. Prototype models for prediction of staffing needs have been developed from this data.

  5. 20 CFR 653.111 - State agency staffing requirements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (1) all “job groups” (as that term is defined by the Office of Federal Contract Compliance Programs.... (2) The affirmative action plans shall include an analysis of the racial and ethnic characteristics... also shall include an analysis of the local office staffing characteristics. The plan shall provide...

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

    ERIC Educational Resources Information Center

    Salt, John; Wood, Peter

    2014-01-01

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

  7. Separation: An Integral Aspect of the Staffing Process.

    ERIC Educational Resources Information Center

    Conley, Valerie Martin

    2001-01-01

    The model of staffing in higher education proposed by Winston and Creamer (1997) includes essential components of recruitment and selection, orientation, supervision, staff development, and performance appraisal. Proposes that the model has a significant oversight-when staff leave their position. Separation is proposed as a necessary component of…

  8. Staffing in Student Affairs: A Survey of Practices.

    ERIC Educational Resources Information Center

    Winston, Roger B., Jr.; Torres, Vasti; Carpenter, D. Stanley; McIntire, David D.; Peterson, Brent

    2001-01-01

    A geographically stratified sample of 263 chief student affairs administrators responded to questions related to their division's professional staff recruiting and selection processes, professional development and activities, and performance appraisal procedures. This produced a descriptive overview of national staffing practice sin student…

  9. An Analysis of Nursing Home Quality Measures and Staffing

    PubMed Central

    Alexander, Gregory L.

    2010-01-01

    Purpose The purpose of this retrospective study was to evaluate nursing home quality measures (QMs) available in a national database called Nursing Home Compare. The aim was to determine whether differences in QM scores occurred with changing staffing-level mix. Subjects All Missouri nursing home facilities were included for the analysis of the 14 QMs downloaded in February 2004. Methods Analyses of variance were used to examine differences in the dependent QM scores; the independent range of staffing levels for 3 disciplines, certified nurse assistant (CNA), licensed practical nurse (LPN), and registered nurse (RN), was analyzed on the basis of their number of hours per resident per day worked in the nursing home. Planned contrasts and post hoc Bonferroni adjustments were calculated to further evaluate significance levels. Finally, residents were used as a covariate to determine effects on significant analyses of variance. Results Care is proportionate to the percentage of CNA/LPN/RN staffing-level mix, with 2 long-stay QMs (percentage of residents who lose bowel or bladder control and percentage of residents whose need for help with activities of daily living has increased) and 2 short-stay measures (percentage of residents who had moderate to severe pain and percentage of residents with pressure ulcers) revealed differences in mean quality scores when staffing levels changed. PMID:18641507

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

    ERIC Educational Resources Information Center

    Keigher, Sharon M.

    1993-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  12. 29 CFR 1952.213 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.213 Section 1952.213 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  13. 29 CFR 1952.153 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.153 Section 1952.153... with OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised... 1980 benchmarks and determined that changes in local conditions and improved inspection data warranted...

  14. 29 CFR 1952.203 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.203 Section 1952.203 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  15. 29 CFR 1952.113 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.113 Section 1952.113 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION..., completed a reassessment of the levels initially established in 1980 and proposed revised compliance...

  16. 29 CFR 1952.373 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.373 Section 1952.373 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  17. 29 CFR 1952.263 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.263 Section 1952.263 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... reassessment of the levels initially established in 1980 and proposed revised benchmarks of 56 safety and 45...

  18. 29 CFR 1952.93 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.93 Section 1952.93 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION..., in conjunction with OSHA, completed a reassessment of the levels initially established in 1980 and...

  19. 29 CFR 1952.223 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.223 Section 1952.223 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  20. 29 CFR 1952.323 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.323 Section 1952.323 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  1. 29 CFR 1952.343 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.343 Section 1952.343 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  2. 29 CFR 1952.233 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.233 Section 1952.233 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  3. 29 CFR 1952.353 - Compliance staffing benchmarks.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Compliance staffing benchmarks. 1952.353 Section 1952.353 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION... OSHA, completed a reassessment of the levels initially established in 1980 and proposed revised...

  4. A Preliminary Analysis of a Strategic Staffing Initiative

    ERIC Educational Resources Information Center

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

    2014-01-01

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

  5. School Staffing Ratios, 1981-82. ERS Report.

    ERIC Educational Resources Information Center

    Educational Research Service, Arlington, VA.

    Intended to make possible the comparison of staffing patterns in one school system with those in systems of similar enrollment size and expenditure level, this report was developed through a national survey of 1,101 school systems conducted in 1981-82. Included are pupil-staff and teacher-staff ratios for individual positions and aggregate…

  6. 25 CFR 275.3 - Methods for staffing.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Methods for staffing. 275.3 Section 275.3 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT... daily on-the-job assignments of Bureau employees. The daily assignments of each such Bureau employee...

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

    ERIC Educational Resources Information Center

    Salt, John; Wood, Peter

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

  9. Staffing Levels in the Dallas Independent School District

    ERIC Educational Resources Information Center

    Council of the Great City Schools, 2009

    2009-01-01

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

  10. 20 CFR 653.111 - State agency staffing requirements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... undertake special efforts to recruit MSFWs and persons from MSFW back-grounds for its staff, shall document...

  11. Collective Bargaining Toolkit: Taking on the Academic Staffing Crisis

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2009

    2009-01-01

    The loss of full-time tenure faculty positions along with the overuse and financial exploitation of contingent faculty (part-time, full-time nontenure track and graduate employees) are roiling higher education around the country. This is called the academic staffing crisis. Many are undoubtedly working through the bargaining process to improve the…

  12. The Challenges of Staffing Urban Schools with Effective Teachers

    ERIC Educational Resources Information Center

    Jacob, Brian A.

    2007-01-01

    Brian Jacob examines challenges faced by urban districts in staffing their schools with effective teachers. He emphasizes that the problem is far from uniform. Teacher shortages are more severe in certain subjects and grades than others, and differ dramatically from one school to another. The Chicago public schools, for example, regularly receive…

  13. 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.,…

  14. 75 FR 11922 - Apria Healthcare, Including On-Site Leased Workers From Corestaff, Ultimate Staffing (Roth...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ..., Ultimate Staffing (Roth Staffing Companies), and Aerotek, Cromwell, CT; Amended Certification Regarding... Healthcare, including on-site leased workers from Corestaff, Cromwell, Connecticut. The notice was published... workers leased from Ultimate Staffing and Aerotek were employed on-site at the Cromwell, Connecticut...

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

    ERIC Educational Resources Information Center

    Castle, Nicholas G.

    2011-01-01

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

  16. 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.

  17. Nurses' work schedule characteristics, nurse staffing, and patient mortality.

    PubMed

    Trinkoff, Alison M; Johantgen, Meg; Storr, Carla L; Gurses, Ayse P; Liang, Yulan; Han, Kihye

    2011-01-01

    Although nurse staffing has been found to be related to patient mortality, there has been limited study of the independent effect of work schedules on patient care outcomes. To determine if, in hospitals where nurses report more adverse work schedules, there would be increased patient mortality, controlling for staffing. A cross-sectional design was used, with multilevel data from a 2004 survey of 633 nurses working in 71 acute nonfederal hospitals in North Carolina and Illinois. Mortality measures were the risk-adjusted Agency for Healthcare Research and Quality Inpatient Quality Indicators, and staffing data were from the American Hospital Association Annual Survey of hospitals. Principal components analysis was conducted on the 12 work schedule items to create eight independent components. Generalized estimating equations were used to examine the study hypothesis. Work schedule was related significantly to mortality when staffing levels and hospital characteristics were controlled. Pneumonia deaths were significantly more likely in hospitals where nurses reported schedules with long work hours (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.17-1.73, p < .01) and lack of time away from work (OR = 1.24, 95% CI = 1.03-1.50, p < .05). Abdominal aortic aneurysm was also associated significantly with the lack of time away (OR = 1.39, 95% CI = 1.11-1.73, p < .01). For patients with congestive heart failure, mortality was associated with working while sick (OR = 1.39, 95% CI = 1.13-1.72, p < .01), whereas acute myocardial infarction was associated significantly with weekly burden (hours per week; days in a row) for nurses (OR = 1.33, 95% CI = 1.09-1.63, p < .01). In addition to staffing, nurses' work schedules are associated with patient mortality. This suggests that work schedule has an independent effect on patient outcomes.

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

    PubMed

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

    2015-02-01

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

  19. Acute psychiatric beds: distribution and staffing in NSW and ACT.

    PubMed

    Rosenman, S

    1995-06-01

    This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. "Gazetted" acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990-1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured. Acute "gazetted" beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. "Non-gazetted" beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability. The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.

  20. [Influence of personnel staffing on patient care and nursing in German intensive care units. Descriptive study on aspects of patient safety and stress indicators of nursing].

    PubMed

    Isfort, M

    2013-02-01

    In this article selected results of a descriptive study on personnel staffing and patient care in German intensive care units are presented and discussed. The main focus is on comparing features of personnel staffing with indicators of the job situation and patient care. The study is based on a standardized survey of nursing managers from 535 intensive care units carried out in 2011. The results show that a low nurse-patient ratio in intensive care units has a tendency to cause higher risks in patient care and also in other stress indicator situations, such as absenteeism.

  1. How have mandated nurse staffing ratios affected hospitals? Perspectives from California hospital leaders.

    PubMed

    Chapman, Susan A; Spetz, Joanne; Seago, Jean Ann; Kaiser, Jennifer; Dower, Catherine; Herrera, Carolina

    2009-01-01

    In 1999, California became the first state to pass legislation mandating minimum nurse-to-patient ratios. Regulations detailing specific ratios by type of hospital unit were released in 2002, with phased-in implementation beginning in 2004 and completed in 2008. These ratios were implemented at a time of severe registered nurse (RN) shortage in the state and a worsening financial position for many hospitals. This article presents an analysis of qualitative data from interviews with healthcare leaders about the impact of nurse staffing ratios. Twenty hospitals (including public, not-for-profit, and for-profit institutions) representing major geographic regions of California were approached. Twelve agreed to participate; semistructured in-person and telephone interviews were conducted with 23 hospital leaders. Several key themes emerged from the analysis. Most hospitals found it difficult and expensive to find more RNs to hire to meet the ratios. Meeting the staffing requirements on all units, at all times, was challenging and had negative impacts, such as a backlog of patients in the emergency department and a decrease of other ancillary staff. Hospital leaders do not believe that ratios have had an impact on patient quality of care. Findings related to nurse satisfaction were mixed. Increased RN staffing improved satisfaction with patient workload, but dissatisfaction with issues of decision-making control (e.g., decisions on when best to take a meal break) were taken out of the nurse's hands to meet ratio requirements. Further research should continue to monitor patient outcomes as other states consider similar ratio regulations. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, high-quality care.

  2. "Unitized Structure and Differentiated Staffing in the Elementary School." DSP Progress Report No. 1: Structure and Staffing.

    ERIC Educational Resources Information Center

    Arends, Richard I.; Essig, Don M.

    This report is the first in a series describing the background, theory, and progress of the Differentiated Staffing Project in the Eugene, Oregon, School District. This particular report reviews the history of the project and outlines the organizational structure that has emerged and developed in the experimental elementary schools. A number of…

  3. Role of integrative pharmacokinetic and pharmacodynamic optimization strategy in the management of Parkinson"s disease patients experiencing motor fluctuations with levodopa.

    PubMed

    Okereke, Chukwuemeka S

    2002-01-01

    Parkinson's disease is a progressively debilitating motor neuron disease that affects the dopaminergic neurons within the nigral-striatal and surrounding pathways and which is characterized clinically by rigidity, resting tremor and bradykinesia with or without postural imbalance. Levodopa is the "gold standard" for the treatment and management of Parkinson's disease worldwide. However, following prolonged use of the drug, the "honey-moon" which was once enjoyed by patients on levodopa begins to wane. The clinical as well as the socio-economic costs associated with such failure in response to levodopa is enormous. Various approaches in the management of Parkinson's disease patients experiencing motor fluctuations with levodopa treatment have been suggested and include both pharmacologic and non-pharmacologic strategies involving invasive surgical intervention. Currently, the non-pharmacological approach, which is invasive, remains to be fully perfected and is associated with high morbidity and mortality. The use of the non-invasive, pharmacological approach is currently the most widely accepted approach but would require a review of all possible drug regimens used. This entails evaluating the pharmacokinetics and pharmacodynamic actions of the drug regimens used and possibly, dosage form and route of administration of the drugs. The use of levodopa formulated for transdermal or intranasal administration might help improve the ease of use and compliance. Controversy abounds as to the role of plasma pharmacokinetics of levodopa in the management of Parkinson's patients, vis a vis its dynamics at the central nerve terminal and its receptor site. However, it is worthy of mention that an integrated optimal pharmacological approach involving the peripheral, and central pharmacokinetics of levodopa as well as its central pharmacodynamics would ensure better treatment and management of this disease. In addition, the choice of alternate formulations and routes of

  4. Staffing the Library Website. SPEC Kit.

    ERIC Educational Resources Information Center

    Ragsdale, Kate, Comp.

    2001-01-01

    This SPEC (Systems and Procedures Exchange Center) Kit presents the results of a survey of Association of Research Libraries (ARL) member libraries designed to gather information about who has responsibility for the development, management, and maintenance of library World Wide Web sites and to determine which combination of human resources works…

  5. 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

  6. Health Promotion and Wellness Staffing Methods

    DTIC Science & Technology

    1999-06-01

    medical treatment are due to drugs, crime, and poor literacy rates. Americans consume huge amounts of health care although many physician visits are simply...Five Health Promotion Goals are: reduce the prevalence of overweight people, increase the number who exercise, decrease cigarette smoking, reduce work...Women’s Health Parenting Pregnancy PT Cholesterol Management VariousSupportGroups Healthy

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

    DTIC Science & Technology

    2013-09-17

    in a low-intensity conflict such as peacekeeping. The military devel- oped a number of enduring base camps such as Camp Bondsteel in Kosovo and Camp...works and engineering support All base camps require provision of potable water, waste water collection and treatment, solid waste collection and...IBCT (TF Red Bulls). Because the BCT also had responsibility for their International Security Assistance Force (ISAF) mission outside the wire

  8. Enforcement of Hospital Nurse Staffing Regulations Across the United States: Progress or Stalemate?

    PubMed

    Serratt, Teresa; Meyer, Suzanne; Chapman, Susan A

    2014-02-01

    Enactment of hospital nurse staffing regulations was brought about by changes in the U.S. health care system that resulted in large-scale reductions in nurse staffing. These reductions came at a time when studies were highlighting inadequacies in care that caused negative patient outcomes and raised questions about the safety of hospitalized patients. Nurse staffing regulations were enacted to ensure that adequate numbers of nurses were available to provide high-quality and safe care. Although these regulations represent progress toward addressing staffing inadequacies, enforcement language is absent or weak and compliance data are either not collected or difficult to access. Explicit and funded enforcement measures need to be included in staffing regulations. Additionally, compliance monitoring and reporting are necessary to evaluate these types of staffing regulations and to determine if they actually achieve the goal of appropriate nurse staffing. © The Author(s) 2014 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

  9. 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

  10. Hospital Staffing and Health Care–Associated Infections: A Systematic Review of the Literature

    PubMed Central

    Stone, Patricia W.; Pogorzelska, Monika; Kunches, Laureen; Hirschhorn, Lisa R.

    2009-01-01

    In the past 10 years, many researchers have examined relationships between hospital staffing and patients’ risk of health care–associated infection (HAI). To gain understanding of this evidence base, a systematic review was conducted, and 42 articles were audited. The most common infection studied was bloodstream infection (n=18; 43%). The majority of researchers examined nurse staffing (n=38; 90%); of these, only 7 (18%) did not find a statistically significant association between nurse staffing variable(s) and HAI rates. Use of nonpermanent staff was associated with increased rates of HAI in 4 studies (P < .05). Three studies addressed infection control professional staffing with mixed results. Physician staffing was not found to be associated with patients’ HAI risk (n=2). The methods employed and operational definitions used for both staffing and HAI varied; despite this variability, trends were apparent. Research characterizing effective staffing for infection control departments is needed. PMID:18767987

  11. 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.

  12. Multi-Source Remote Sensing to Observe Impacts of Fluctuating Management and Climate on Riparian Vegetation of the Rio Grande: 1935 to 2014

    NASA Astrophysics Data System (ADS)

    Petrakis, R.; Tashjian, P.; Russo, R. D.; Thomson, B.; Van Leeuwen, W. J. D.

    2015-12-01

    Large rivers of the Southwestern United States are central to both ecological and human communities. Complex relationships exist between water policy, management, and natural ecosystems. The San Acacia Reach of the Rio Grande in central New Mexico, a 50 mile stretch from San Acacia to San Marcial, has experienced multiple management and climate fluctuations over the past 80 years, resulting in threats to riparian and aquatic ecosystems. These changes have included channelization of the river, reduced seasonal flooding due to upstream dams and conveyance channels, and varying river flows as a result of drought cycles. Understanding how the location and composition of vegetation has responded to these changes is essential in understanding the larger influence on the riparian vegetation which surrounds the river. This research used remote sensing data, land cover change analysis, GIS, and a review of the on-the-ground management decisions to accomplish the following goals: 1) determine how the channel has changed spatially over time, 2) determine the location and composition of vegetation change, and 3) determine potential linkages between management and the terrestrial and aquatic ecosystems. This research focused on four research periods which provide unique opportunities to observe a direct relationship between river management and land cover change. The periods are: 1) 1935 to 1962, 2) 1962 to 1987, 3) 1987 to 1999, and 4) 1999 to 2014. Initial results show increased invasive vegetation growth in response to early large scale, basin-wide changes in river management. Between 1962 and 1987, invasive forest/woodland land cover increased by more than 250%. However, as a result of restoration efforts over the past 25 years, combined with periods of increased precipitation and an aging ecosystem limiting new growth, native vegetation has responded and invasive vegetation growth has slowed. This has occurred despite a more constricted and incised river channel. Overall

  13. 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.

  14. Staffing levels in rural nursing homes: a mixed methods approach.

    PubMed

    Towsley, Gail L; Beck, Susan L; Dudley, William N; Pepper, Ginette A

    2011-07-01

    This mixed methods study used multiple regression analyses to examine the impact of organizational and market characteristics on staffing hours and staffing mix, and qualitative interview to explore the challenges and facilitators of recruiting and retaining qualified staff. Rural nursing homes (NHs) certified by Medicare or Medicaid (N = 161) were sampled from the Online Survey Certification and Reporting system. A subsample (n = 23) was selected purposively for the qualitative analysis. Smaller NHs or government-affiliated homes had more total nursing hours per resident day and more hours of care by certified nursing assistants and RNs than larger and nongovernment-affiliated homes; however, almost 87% of NHs in this study were below the national recommendation for RN hours. Informants voiced challenges related to enough staff, qualified staff, and training staff. Development of nursing resources is critical, especially in rural locales where aging resources may not be well developed.

  15. Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

    PubMed Central

    Forster, Della A; McLachlan, Helen L; Yelland, Jane; Rayner, Jo; Lumley, Judith; Davey, Mary-Ann

    2006-01-01

    Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73), exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning). Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives) and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives) providing postnatal care. Staffing issues impact on

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

    PubMed

    Kalisch, Beatrice J; Lee, Hyunhwa

    2009-01-01

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

  17. Manpower Staffing, Emergency Department Access and Consequences on Patient Outcomes

    DTIC Science & Technology

    2007-06-01

    squares and fixed effects techniques to determine the effect of ED access on mortality rates . In particular, we examine two measures of ED access...distance and mortality rates . However, for diversion hours, we find it counterintuitive that increasing diversion hours reduces mortality rates . Further study will need to be done to verify this finding....diversion trends, (2) effect of ED staffing, capacity and financial characteristics on ED diversion hours and (3) effect of changes in ED access on mortality

  18. Nurse Staffing Patterns and Patient Experience of Care: An Empirical Analysis of U.S. Hospitals.

    PubMed

    Oppel, Eva-Maria; Young, Gary J

    2017-08-14

    To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility. The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. An observational research design was used entailing a pooled, cross-sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix-percentage of registered nurses; staffing flexibility-percentage of part-time nurses). All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns. © Health Research and Educational Trust.

  19. Nurse staffing in a decentralized organization: part II.

    PubMed

    Althaus, J N; Hardyck, N M; Pierce, P B; Rodgers, M S

    1982-04-01

    It must be emphasized that none of the steps described in this planning process emerged overnight. Rather, they were achieved through a process of evolution, sometimes through trial and error, and always with consultation and participation by many members of the hospital nursing staff. Participation by many in the process of planning for a workable staffing system has been essential to its success. Indeed, creative scheduling by the head nurse is possible because of the way in which the system has been organized. The fact that head nurses are responsible for staffing their own units makes it infinitely easier for them to see what they need to make their units operate effectively and efficiently. Creative scheduling includes the possibility of arranging nurses' hours outside the rigid three-shift schedule used by so many hospitals. Many El Camino nurses now report for work at different hours. In addition, the use of flexible work weeks has proven valuable. Some head nurses now allow for a ten-hour, four-day work week; in emergency staffing situations there have, on occasion, been twelve-hour days. Even as this system evolves, it faces change. Just as the requirements for staff cannot be rigid, so must problem solving be flexible and constantly under review. The fact that El Camino believes in constant monitoring of its system is essential to its success. A key philosophical foundation of decentralization is that it must be subject to change. This is no less true in staffing than in other parts of the decentralization structure. By agreeing that change is constant and necessary and that participation is required at all levels of the staffing planning process, we have constructed the outlines of a system that will work in the future as well as it does in the present. Our system centers around the head nurses. It involves their planning; thus it also involves the support of those members of the nursing staff who can provide essential information. But the decisions

  20. Population Structure of mtDNA Variation due to Pleistocene Fluctuations in the South American Maned Wolf (Chrysocyon brachyurus, Illiger, 1815): Management Units for Conservation.

    PubMed

    González, Susana; Cosse, Mariana; Franco, María del Rosario; Emmons, Louise; Vynne, Carly; Duarte, José Maurício Barbanti; Beccacesi, Marcelo D; Maldonado, Jesús E

    2015-01-01

    The maned wolf (Chrysocyon brachyurus) is one of the largest South American canids, and conservation across this charismatic carnivore's large range is presently hampered by a lack of knowledge about possible natural subdivisions which could influence the population's viability. To elucidate the phylogeographic patterns and demographic history of the species, we used 2 mtDNA markers (D-loop and cytochrome b) from 87 individuals collected throughout their range, in Argentina, Bolivia, Brazil, and Uruguay. We found moderate levels of haplotype and nucleotide diversity, and the 14 D-loop haplotypes were closely related. Genetic structure results revealed 4 groups, and when coupled with model inferences from a coalescent analysis, suggested that maned wolves have undergone demographic fluctuations due to changes in climate and habitat during the Pleistocene glaciation period approximately 24000 years before present (YBP). This genetic signature points to an event that occurred within the timing estimated for the start of the contraction of the Cerrado around 50000 YBP. Our results reveal a genetic signature of population size expansion followed by contraction during Pleistocene interglaciations, which had similar impacts on other South American mammals. The 4 groups should for now be considered management units, within which future monitoring efforts should be conducted independently. © The American Genetic Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

    PubMed

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

    2015-08-01

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

  2. Lower Nurse Staffing Levels Are Associated With Occurrences of Inpatient Falls at a Large Pediatric Hospital.

    PubMed

    Hagan, Joseph; Jones, Angela

    2015-01-01

    No previous research has been published regarding the relationship between nurse staffing levels and inpatient pediatric falls, and previous research in the adult population has yielded conflicting results, probably due in many instances to suboptimal study design. The objective of this study was to examine the relationship between nurse staffing levels and pediatric patient falls in a large children's hospital. A case-control study design was used to compare the nurse staffing level during the shift of patient falls to the staffing level in the same units on shifts when patient falls did not occur. Nurse staffing levels were significantly lower in units when patient falls occurred, particularly during night shift. Targeted nurse staffing interventions in high-risk units could reduce the incidence of inpatient pediatric falls.

  3. Rehabilitation and staffing levels in a 'new look' hospital-hostel.

    PubMed

    Allen, H; Baigent, B; Kent, A; Bolton, J

    1993-02-01

    The present study examined the utility of a new hospital-hostel with low staffing levels. Results showed that the hostel was able to maintain 9 of the 10 initially transferred patients and has been able to provide some improvements in their quality of life. However, unlike highly staffed hospital-hostels, it was not able to decrease patients' disabilities. Implications of this are discussed in relation to staffing levels and practices.

  4. The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System.

    PubMed

    Cortez, Eric J; Panchal, Ashish R; Davis, James E; Keseg, David P

    2017-01-18

    Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]).

  5. The Relationship between the Level of Nurse Staffing and Nursing Incidents

    DTIC Science & Technology

    1992-01-01

    Relationship Between the Level of Nurse Staffing D T IC and Nursing Incidents DI 6. AUTHOR(S) ’-lELECTE I Susan J. Helm, Lt. Col. AG 9:A! 7...Research Reports. Author: Susan L. Helm Title: The Relationship Between the Level of Nurse Staffing and Nursing Incidents Rank: LtCol Service: U.S...R.N., Ph.D Determined the relationship between the level of nurse staffing and nursing incidents . The study was based on two samples: (1)

  6. Relationships Between Nurse Staffing and Patients' Experiences, and the Mediating Effects of Missed Nursing Care.

    PubMed

    Cho, Sung-Hyun; Mark, Barbara A; Knafl, George; Chang, Hyoung Eun; Yoon, Hyo-Jeong

    2017-05-01

    The aims of this study were to examine the relationships between nurse staffing and patients' experiences, and to determine the mediating effects of patient-reported missed care on the relationship between nurse staffing and patients' experiences. The study included 362 nurses and 208 patients from 23 nursing units of six hospitals in South Korea. Nurse staffing was measured by patient-to-nurse ratios and by nurse- and patient-perceived staffing adequacy. Patients' experiences included adverse events, communication with nurses, and overall hospital rating. Patient-reported missed care was measured using the MISSCARE Survey-Patient with three domains: communication, basic care, and timely response. Lower nurse-perceived staffing adequacy was associated with more patient-reported missed communication. Lower patient-perceived staffing adequacy was associated with more missed care and adverse events, and a lower likelihood of experiencing good communication with nurses and of giving a high overall rating to the hospital. Patient-reported missed care mediated the relationship between nurse staffing and patients' experiences. Nurse staffing adequacy, particularly as perceived by patients, was significantly associated with patient-reported missed communication and basic care, as well as patients' experiences. Appropriate nurse staffing is required to reduce missed care and to improve patients' experiences. © 2017 Sigma Theta Tau International.

  7. Evaluating nursing hours per patient day as a nurse staffing measure.

    PubMed

    Min, Ari; Scott, Linda D

    2016-05-01

    To identify the techniques used to measure nurse staffing and to evaluate the reliability, validity and limitations of nursing hours per patient day (NHPPD). Numerous studies have attempted to identify appropriate nurse staffing levels; however, variations in nurse staffing measures may have caused inconsistent findings regarding the relationships between nurse staffing and quality of care. Seventeen studies using nurse staffing measures were reviewed. Six common nurse staffing measures were identified: nurse-to-patient ratios, full-time equivalents, NHPPD, skill mix, nurse-perceived staffing adequacy and nurse-reported number of assigned patients. Among nurse staffing measures, NHPPD is the most frequently used and is considered to be highly beneficial. This measure shows some evidence of high inter-rater reliability. The predictive validity of NHPPD for patient falls is high, whereas that for pressure ulcers is low. For NHPPD to be applied more effectively as a nurse staffing measure, there is a need for additional reliability testing in various types of units with large sample sizes; further validity research for additional patient outcomes; appropriate adjustments in its application to capture variations in the characteristics of nurses, patients and hospital units; and a consistent data collection procedure. © 2015 John Wiley & Sons Ltd.

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

    PubMed

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

    2009-01-01

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

  9. When caring stops, staffing doesn't matter: part II.

    PubMed

    Douglas, Kathy

    2011-01-01

    Response to a column on caring and staffing struck a cord with Nursing Economic$ readers worldwide. Measuring caring is complicated and a healthy debate exists over how exactly to do it. The extraordinary work of Dr. Jean Watson is an excellent resource for understanding how to measure and monitor caring. Beneath the instruments for measuring caring sits foundational work that can help us clarify and understand the topic of caring and just where it sits in our philosophies, intentions, patient care models, and care delivery systems.

  10. A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre-post intervention study.

    PubMed

    Yu, Dongmei; Ma, Yuqin; Sun, Qingwen; Lu, Gendi; Xu, Ping

    2015-08-01

    We aimed to evaluate the effectiveness of a nursing care classification system for re-assessing nurse workload and determining staffing needs. Adequate bed-nurse ratios help manage hospital cost-efficiency, quality of care and patient safety. A prospective pre-post intervention study was conducted from January 2010 to December 2012 in 16 medical-surgical units of a tertiary teaching hospital. Nursing tasks were classified into four grades of care reflecting actual workload. Units were re-staffed accordingly and bed-nurse ratios compared with government-authorized bed-nurse ratios. Patient satisfaction, hospital stays and mortality were evaluated pre- and poststaffing changes. Average bed-nurse ratio (1:0.41) exceeded the national standard (1:0.40) in 16 units, but was inadequate in five units. Re-staffing increased average bed-nurse ratio from 1:0.41 to 1:0.48. Patients' satisfaction increased from 96.9% to 97.6%, and hospital stays decreased significantly. Nursing care classification effectively distributes nurse staffing to match patients' care levels, improving patient outcomes. © 2014 Wiley Publishing Asia Pty Ltd.

  11. Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy.

    PubMed

    McQuide, Pamela A; Kolehmainen-Aitken, Riitta-Liisa; Forster, Norbert

    2013-12-10

    As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization. The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers. The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level. WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses' workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7) and health centers (range = 2 to 57). The utility of

  12. Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy

    PubMed Central

    2013-01-01

    Introduction As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization. Application The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers. Challenges The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level. Findings WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses’ workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7

  13. Managing Community College Public Relations: An Overview.

    ERIC Educational Resources Information Center

    Romine, Larry

    1982-01-01

    Since planning is a continual process, the college public relations manager plans for what could occur and prepares for it. The manager's responsibilities include working with the board and president, budgeting, setting objectives, innovating, representing, staffing, coordinating, and directing. (MSE)

  14. Elliptic Flow Fluctuations

    NASA Astrophysics Data System (ADS)

    Mrowczynski, Stanislaw; Shuryak, Edward V.

    2003-08-01

    We suggest to perform systematic measurements of the elliptic flow fluctuations which are sensitive to the early stage dynamics of heavy-ion collisions at high-energies. Significant flow fluctuations are shown to be generated due to the formation of topological clusters and development of the filamentation instability. The statistical noise and hydrodynamic fluctuations are also estimated.

  15. Nurse staffing, burnout, and health care–associated infection

    PubMed Central

    Cimiotti, Jeannie P.; Aiken, Linda H.; Sloane, Douglas M.; Wu, Evan S.

    2012-01-01

    Background Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association. Methods We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care–associated infections. Results There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million. Conclusions We provide a plausible explanation for the association between nurse staffing and health care–associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities. PMID:22854376

  16. Nurse staffing, burnout, and health care-associated infection.

    PubMed

    Cimiotti, Jeannie P; Aiken, Linda H; Sloane, Douglas M; Wu, Evan S

    2012-08-01

    Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association. We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care-associated infections. There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million. We provide a plausible explanation for the association between nurse staffing and health care-associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  17. Implications of the California Nurse Staffing Mandate for Other States

    PubMed Central

    Aiken, Linda H; Sloane, Douglas M; Cimiotti, Jeannie P; Clarke, Sean P; Flynn, Linda; Seago, Jean Ann; Spetz, Joanne; Smith, Herbert L

    2010-01-01

    Objectives To determine whether nurse staffing in California hospitals, where state-mandated minimum nurse-to-patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. Data Sources Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. Study Design Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure-to-rescue, are affected by the differences in nurse workloads across the hospitals in these states. Principal Findings California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California-mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Conclusions Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur. PMID:20403061

  18. Dietary Service Staffing Impact Nutritional Quality in Nursing Homes.

    PubMed

    Smith, Kelly M; Thomas, Kali S; Johnson, Shanthi; Meng, Hongdao; Hyer, Kathryn

    2017-01-01

    To examine the relationship between dietary service staff and dietary deficiency citations in nursing homes (NHs). 2007-2011 Online Survey and Certification and Reporting data for 14,881 freestanding NHs were used to examine the relationship between dietary service staff and the probability of receiving a dietary service-related deficiency citation. An unconditional logit model with random effects was employed. Findings suggest that higher staffing levels for dietitians (odds ratio [OR] = .955; p < .01), dietary service personnel (OR = .996; p < .01), and certified nursing assistants (CNAs; OR = .981; p < .05) decrease the likelihood of receiving a dietary service deficiency citation. Higher levels of dietary service and CNA staffing levels have the potential to improve the quality of nutritional care in NHs. Findings help substantiate the Centers for Medicare and Medicaid Services' proposed rules for more stringent Food and Nutrition Services in the NH setting and signify the need for further research relative to the impact of dietary service staff on nutritional and clinical outcomes.

  19. Impact of New York State's new licensure regulations for laboratory professionals on staffing of clinical laboratories.

    PubMed

    Balachandran, Indra; Walker, Joe W; Taylor, Jean; Cheng, Michael; Wheeler, M Elyse

    2009-01-01

    Licensing of laboratory professionals has been a controversial issue for the individuals working in these professions for many years. In New York State (NYS), licensing of laboratory professionals has been debated for over three decades and did not become law until 2005. The NYS licensure law stipulates specific educational requirements that include course work as well as curricular content areas. In addition to these educational requirements, the licensure law stipulates successful completion of a certification examination for new licensure applicants. To determine if the new legislation in NYS has had a demonstrable impact on the ability to recruit qualified laboratory professionals, a survey tool was developed to gather baseline data for a longitudinal study on the same topic. A 20 item survey along with a letter of explanation and a self addressed return envelope was distributed by mail to managers and/or supervisors of laboratories in 150 hospitals that ranged in size from small community hospitals to large medical centers across the state of New York. Questions were created addressing each of the following categories: day to day laboratory staffing, increased cost of recruiting to the facility after licensure law, impact on ability to cross train and staff evenings and weekends, and impact on patient care. It is apparent from the survey results that the employers have already started experiencing difficulty to staff certain laboratory vacancies especially for Clinical Laboratory Technologists (CLT) and fear that this trend might continue over the years not only pertaining to CLT but also to other laboratory vacancies such as Histotechnologists-Histotechnicians and Cytotechnologists. The impact of the NYS licensure law on staffing, facility costs, patient care, and laboratory professionals are discussed.

  20. 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)

  1. 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)

  2. 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…

  3. 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…

  4. 7 CFR 800.148 - Maintenance and retention of records on organization, staffing, and budget.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., staffing, and budget. 800.148 Section 800.148 Agriculture Regulations of the Department of Agriculture... retention of records on organization, staffing, and budget. (a) Organization. Agencies, contractors, and...) information about the training that each employee has received, and (5) related information required by the...

  5. Staffing Levels and Inpatient Outcomes at Military Health Care Facilities: A Resource-Based View

    DTIC Science & Technology

    2004-01-01

    average length of stay , in-house mortality rates, and 30-day readmission rates. The current study found some support that increasing nurse staffing...especially registered nurse staffing, does lead to better inpatient quality outcomes as defined by shorter average length of stay and lower inpatient mortality rates.

  6. Regular Faculty Staffing for an Expanded First-Year Research and Writing Course: A Post Mortem.

    ERIC Educational Resources Information Center

    Rombauer, Marjorie Dick

    1980-01-01

    Complexities involved in staffing a legal research and writing program with regular faculty members, as contrasted with instructors or teaching assistants, are addressed. Development, implementation, and maintenance of regular staffing are discussed. Available from Union University, 80 Scotland Ave., Albany, NY 12208; $2.50, entire issue. (MSE)…

  7. 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

    ... firm were engaged in employment related to the production of light centrifugal pump products. At the... received information that workers from Remedy Intelligent Staffing, Labor Ready, and DriveForce... certification to include workers leased from Remedy Intelligent Staffing, Labor Ready, and DriveForce...

  8. 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,…

  9. Research on Nurse Staffing in Hospitals; Report of the Conference, May 1972.

    ERIC Educational Resources Information Center

    Levine, Eugene, Ed.

    The conference brought together 45 persons who have had extensive experience in nurse staffing research. After the leadoff paper by Myrtle K. Aydelotte, which presented an overview of nurse staffing research, 10 papers were presented on variables considered to be significant in influencing the quantitative and qualitative demand for nurse…

  10. The Influence of Nurse Wage Differentials on Nursing Home Staffing and Resident Care Decisions.

    ERIC Educational Resources Information Center

    Zinn, Jacqueline S.

    1993-01-01

    Examined extent to which nursing homes adjust staffing and care practices relative to local market conditions. Results suggest that facilities employ more nonprofessional nursing staff in markets in which professional nurse wages are higher. Registered nurse staffing levels are higher in markets with higher percentage of self-pay nursing home…

  11. Studies on Nurse staffing and Healthcare Associated Infection: Methodological Challenges and Potential Solutions

    PubMed Central

    Shang, Jingjing; Stone, Patricia; Larson, Elaine

    2015-01-01

    Background Researchers have been studying hospital nurse staffing in relation to healthcare associated infections (HAIs) for over two decades, and the results have been mixed. We summarized published research examining these issues, critically analyzed the commonly used approaches, identified methodologic challenges, proposed potential solutions, and suggested the possible benefits of applying an electronic health record (EHR) system. Method A scoping review was conducted using Medline and Cumulative Index to Nursing and Allied Health Literature since 1990. Original research studies examining relationships between nurse staffing and HAIs in the hospital setting and published in peer-reviewed English-language journals were selected. Results A total of 125 articles/abstracts were identified and 45 met inclusion criteria. Findings from these studies were mixed. The methodologic challenges identified included database selection, variable measurement, methods to link the nurse staffing and HAI data and addressing temporality. Administrative staffing data were often not precise or specific. The most common method to link staffing and HAI data did not assess the temporal relationship. We proposed using daily staffing information 2–4 days prior to HAI onset linked to individual patient HAI data. Discussion To assess the relationships between nurse staffing and HAIs, methodological decisions are necessary based on what data are available and feasible to obtain. National efforts to promote EHR may offer solutions for future studies by providing more comprehensive data on HAIs and nurse staffing. PMID:26042847

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

    ERIC Educational Resources Information Center

    Paulus, Amy R.

    2014-01-01

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

  13. 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…

  14. 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…

  15. Correlates of Client Satisfaction at Trainee and Professionally Staffed Counseling Centers.

    ERIC Educational Resources Information Center

    DeVito, Anthony J.; And Others

    Researchers have found differences in client perceptions of and judgments about experienced and inexperienced counselors. To investigate the correlates of client satisfaction in two counseling centers, one staffed primarily by trainees (CC-T) and one staffed primarily by professionals (CC-P), 464 questionnaires (107 or 26 percent at CC-T; 357 or…

  16. 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…

  17. Regular Faculty Staffing for an Expanded First-Year Research and Writing Course: A Post Mortem.

    ERIC Educational Resources Information Center

    Rombauer, Marjorie Dick

    1980-01-01

    Complexities involved in staffing a legal research and writing program with regular faculty members, as contrasted with instructors or teaching assistants, are addressed. Development, implementation, and maintenance of regular staffing are discussed. Available from Union University, 80 Scotland Ave., Albany, NY 12208; $2.50, entire issue. (MSE)…

  18. Studies on nurse staffing and health care-associated infection: methodologic challenges and potential solutions.

    PubMed

    Shang, Jingjing; Stone, Patricia; Larson, Elaine

    2015-06-01

    Researchers have been studying hospital nurse staffing in relation to health care-associated infections (HAIs) for >2 decades, and the results have been mixed. We summarized published research examining these issues, critically analyzed the commonly used approaches, identified methodologic challenges, proposed potential solutions, and suggested the possible benefits of applying an electronic health record (EHR) system. A scoping review was conducted using MEDLINE and CINAHL from 1990 onward. Original research studies examining relationships between nurse staffing and HAIs in the hospital setting and published in peer-reviewed English-language journals were selected. A total of 125 articles and abstracts were identified, and 45 met inclusion criteria. Findings from these studies were mixed. The methodologic challenges identified included database selection, variable measurement, methods to link the nurse staffing and HAI data, and temporality. Administrative staffing data were often not precise or specific. The most common method to link staffing and HAI data did not assess the temporal relationship. We proposed using daily staffing information 2-4 days prior to HAI onset linked to individual patient HAI data. To assess the relationships between nurse staffing and HAIs, methodologic decisions are necessary based on what data are available and feasible to obtain. National efforts to promote an EHR may offer solutions for future studies by providing more comprehensive data on HAIs and nurse staffing. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Structures, Services and Staffing in Learning Resource Centers in Selected California Community Colleges.

    ERIC Educational Resources Information Center

    Jensen, Mary E.

    A survey of learning resource centers in 15 California community colleges was conducted to aid the staff of the West Valley College center in determining what changes to make in organizational structure, administration, services, and staffing. The survey instrument elicited information on staffing in various departments, work loads, service hours,…

  20. 75 FR 16512 - Willstaff Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-01

    ... Employment and Training Administration Willstaff Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial... under a separate unemployment insurance (UI) tax account under the name Willstaff Crystal, Inc... follows: All workers of Willstaff Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources...

  1. Workload Management System for Nurses: Application to the Burn Unit

    DTIC Science & Technology

    1990-06-01

    nursing care . The Workload Management System for Nurses (WMSN), which is based on direct and indirect nursing care research, prospectively classifies patients on the basis of direct care requirements and then establishes staffing levels on the basis of both direct care and indirect care workloads. Application of the Department of Defense WMSN to the military burn research center if feasible and has provided data for objective staffing adjustments and validated staffing requirements. In addition, several other quality assurance implications have been

  2. Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in United States hospitals.

    PubMed

    Bond, C A; Raehl, Cynthia L

    2006-06-01

    Adverse drug reactions (ADRs) were examined in 1,960,059 hospitalized Medicare patients in 584 United States hospitals in 1998. A database was constructed from the MedPAR database and the National Clinical Pharmacy Services survey. The 584 hospitals were selected because they provided specific information on 14 clinical pharmacy services and on pharmacy staffing; they also had functional ADR reporting systems. The study population consisted of 35,193 Medicare patients who experienced an ADR (rate of 1.8%). Of the 14 clinical pharmacy services, 12 were associated with reduced ADR rates. The most significant reductions occurred in hospitals offering pharmacist-provided admission drug histories (odds ratio [OR] 1.864, 95% confidence interval [CI] 1.765-1.968), drug protocol management (OR 1.365, 95% CI 1.335-1.395), and ADR management (OR 1.360, 95% CI 1.328-1.392). Multivariate analysis, performed to further evaluate these findings, showed that nine variables were associated with ADR rate: pharmacist-provided in-service education (slope -0.469, p=0.018), drug information (slope -0.488, p=0.005), ADR management (slope -0.424, p=0.021), drug protocol management (slope -0.732, p=0.002), participation on the total parenteral nutrition team (slope 0.384, p=0.04), participation on the cardiopulmonary resuscitation team (slope -0.506, p=0.008), medical round participation (slope -0.422, p=0.037), admission drug histories (slope -0.712, p=0.008), and increased clinical pharmacist staffing (slope -4.345, p=0.009). As clinical pharmacist staffing increased from the 20th to the 100th percentile (from 0.93+/-0.77/100 to 5.16+/-4.11/100 occupied beds), ADRs decreased by 47.88%. In hospitals without pharmacist-provided ADR management, the following increases were noted: mean number of ADRs/100 admissions by 34.90% (OR 1.360, 95% CI 1.328-1.392), length of stay 13.64% (Mann-Whitney U test [U]=11047367, p=0.017), death rate 53.64% (OR 1.574, 95% CI 1.423-1.731), total Medicare

  3. A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs.

    PubMed

    Scherzer, Rachel; Dennis, Marie P; Swan, Beth Ann; Kavuru, Mani S; Oxman, David A

    2017-02-01

    To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013. Large urban academic university hospital. One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19.1%) and 936 resident-staffed medical ICU admissions (80.9%). None. Data obtained included age, gender, race, medical ICU admitting diagnosis, location at time of ICU transfer, code status at ICU admission, and severity of illness using both Acute Physiology and Chronic Health Evaluation II scores and a model for relative expected mortality. Primary outcomes compared included ICU mortality, in-hospital mortality, medical ICU length of stay, and post-ICU discharge hospital length of stay. Patients admitted to the nurse practitioner-staffed medical ICU were older (63 ± 16.5 vs 59.2 ± 16.9 yr for resident-staffed medical ICU; p = 0.019), more likely to be transferred from an inpatient unit (52.0% vs 40.0% for the resident-staffed medical ICU; p = 0.002), and had a higher severity of illness by relative expected mortality (21.3 % vs 17.2 % for the resident-staffed medical ICU; p = 0.001). There were no differences among primary outcomes except for medical ICU length of stay (nurse practitioner-resident-staffed 7.9 ± 7.5 d vs resident-staffed medical ICU 5.6 ± 6.5 d; p = 0.0001). Post-hospital discharge to nonhome location was also significantly higher in the nurse practitioner-ICU (31.7% in nurse practitioner-staffed medical ICU vs 23.9% in resident-staffed medical ICU; p = 0.24). We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.

  4. Effects of hospital staffing and organizational climate on needlestick injuries to nurses.

    PubMed

    Clarke, Sean P; Sloane, Douglas M; Aiken, Linda H

    2002-07-01

    This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries.

  5. Effects of Hospital Staffing and Organizational Climate on Needlestick Injuries to Nurses

    PubMed Central

    Clarke, Sean P.; Sloane, Douglas M.; Aiken, Linda H.

    2002-01-01

    Objectives. This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. Methods. We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. Results. Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. Conclusions. Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries. PMID:12084694

  6. 25 CFR 36.81 - May a homeliving program use support staff or teachers to meet behavioral health staffing...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... meet behavioral health staffing requirements? 36.81 Section 36.81 Indians BUREAU OF INDIAN AFFAIRS... program use support staff or teachers to meet behavioral health staffing requirements? No, a homeliving program must not use support staff or teachers to meet behavioral health staffing requirements. The only...

  7. 25 CFR 36.81 - May a homeliving program use support staff or teachers to meet behavioral health staffing...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... meet behavioral health staffing requirements? 36.81 Section 36.81 Indians BUREAU OF INDIAN AFFAIRS... program use support staff or teachers to meet behavioral health staffing requirements? No, a homeliving program must not use support staff or teachers to meet behavioral health staffing requirements. The only...

  8. 75 FR 452 - Tenneco, Inc.; Including On-Site Workers From Elite Staffing, Inc.; Cozad, NE; Tenneco, Inc...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-05

    ...] Tenneco, Inc.; Including On-Site Workers From Elite Staffing, Inc.; Cozad, NE; Tenneco, Inc.; Including On-Site Leased Workers of Elite Staffing, Inc.; Monroe, MI; Amended Certification Regarding Eligibility To... include on-site leased workers from Elite Staffing, Inc. The Notice of amendment will soon be published...

  9. 1995 IAHSS salary, equipment, staffing and uniform survey.

    PubMed

    Stultz, M S

    This second part of the 1995 IAHSS annual Crime Survey provides information on security director salaries, security department staffing, and types of equipment and uniforms employed. Factors that may or may not affect salaries are explored--including the influence of hospital size and the differences between proprietary and contract status. Differences in the size of security staffs by bed size and the relative use of police officers in security are covered. The survey also reports on trends in the type of security equipment used by hospitals--including guns, stun guns, pepper spray, and Mace. New data on the use of police uniforms or blazers by security personnel are presented. Ten charts are included.

  10. A multisite study of nurse staffing and patient occurrences.

    PubMed

    Blegen, M A; Vaughn, T

    1998-01-01

    Restructuring of nursing care models has led to more "non-professional" caregivers, sometimes called unlicensed assistive personnel (UAPs) who provide more of the basic delegable direct patient care activities in collaboration with RNs. The purpose of this study, wherein data were collected from 39 units in 11 hospitals, was to determine the relationship between different levels of nurse staffing and patient outcomes (adverse occurrences). Using and tracking the same indicators of patient quality outcomes over a significant time period in different institutions with similar patient groups would greatly enhance the usefulness of such data. Among the more surprising findings in this study was the "non-linear" relationship between the proportion of RNs in the staff mix and MAEs. As the proportion of RNs on a unit increased from 50% to 85% "the rate of MAEs declined, but as the RN proportion increased from 85% to 100% the rate of MAEs increased." Further investigations are needed to explain this finding.

  11. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review.

    PubMed

    Pronovost, Peter J; Angus, Derek C; Dorman, Todd; Robinson, Karen A; Dremsizov, Tony T; Young, Tammy L

    2002-11-06

    Intensive care unit (ICU) physician staffing varies widely, and its association with patient outcomes remains unclear. To evaluate the association between ICU physician staffing and patient outcomes. We searched MEDLINE (January 1, 1965, through September 30, 2001) for the following medical subject heading (MeSH) terms: intensive care units, ICU, health resources/utilization, hospitalization, medical staff, hospital organization and administration, personnel staffing and scheduling, length of stay, and LOS. We also used the following text words: staffing, intensivist, critical, care, and specialist. To identify observational studies, we added the MeSH terms case-control study and retrospective study. Although we searched for non-English-language citations, we reviewed only English-language articles. We also searched EMBASE, HealthStar (Health Services, Technology, Administration, and Research), and HSRPROJ (Health Services Research Projects in Progress) via Internet Grateful Med and The Cochrane Library and hand searched abstract proceedings from intensive care national scientific meetings (January 1, 1994, through December 31, 2001). We selected randomized and observational controlled trials of critically ill adults or children. Studies examined ICU attending physician staffing strategies and the outcomes of hospital and ICU mortality and length of stay (LOS). Studies were selected and critiqued by 2 reviewers. We reviewed 2590 abstracts and identified 26 relevant observational studies (of which 1 included 2 comparisons), resulting in 27 comparisons of alternative staffing strategies. Twenty studies focused on a single ICU. We grouped ICU physician staffing into low-intensity (no intensivist or elective intensivist consultation) or high-intensity (mandatory intensivist consultation or closed ICU [all care directed by intensivist]) groups. High-intensity staffing was associated with lower hospital mortality in 16 of 17 studies (94%) and with a pooled estimate of

  12. Proteins, fluctuations and complexity

    SciTech Connect

    Frauenfelder, Hans; Chen, Guo; Fenimore, Paul W

    2008-01-01

    Glasses, supercooled liquids, and proteins share common properties, in particular the existence of two different types of fluctuations, {alpha} and {beta}. While the effect of the {alpha} fluctuations on proteins has been known for a few years, the effect of {beta} fluctuations has not been understood. By comparing neutron scattering data on the protein myoglobin with the {beta} fluctuations in the hydration shell measured by dielectric spectroscopy we show that the internal protein motions are slaved to these fluctuations. We also show that there is no 'dynamic transition' in proteins near 200 K. The rapid increase in the mean square displacement with temperature in many neutron scattering experiments is quantitatively predicted by the {beta} fluctuations in the hydration shell.

  13. Fluctuations in Cerebral Hemodynamics

    DTIC Science & Technology

    2003-12-01

    Determination of scaling properties Detrended Fluctuations Analysis (see (28) and references therein) is commonly used to determine scaling...pressure (averaged over a cardiac beat) of a healthy subject. First 1000 values of the time series are shown. (b) Detrended fluctuation analysis (DFA...1000 values of the time series are shown. (b) Detrended fluctuation analysis of the time series shown in (a). Fig . 3 Side-by-side boxplot for the

  14. Fluctuation relations for spintronics.

    PubMed

    López, Rosa; Lim, Jong Soo; Sánchez, David

    2012-06-15

    Fluctuation relations are derived in systems where the spin degree of freedom and magnetic interactions play a crucial role. The form of the nonequilibrium fluctuation theorems relies on the assumption of a local balance condition. We demonstrate that in some cases the presence of magnetic interactions violates this condition. Nevertheless, fluctuation relations can be obtained from the microreversibility principle sustained only at equilibrium as a symmetry of the cumulant generating function for spin currents. We illustrate the spintronic fluctuation relations for a quantum dot coupled to partially polarized helical edge states.

  15. 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.

  16. The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure.

    PubMed

    Giuliano, Karen K; Danesh, Valerie; Funk, Marjorie

    2016-01-01

    The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report "Best Hospitals" survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes.

  17. How Does Rurality Influence the Staffing of Social Service Departments in Nursing Homes?

    PubMed

    Roberts, Amy Restorick; Bowblis, John R

    2017-01-09

    Social service departments in nursing homes (NHs) are staffed by qualified social workers (QSWs) and paraprofessionals. Due to greater workforce challenges in rural areas, this article aims to describe the staffing levels and composition of these departments by rurality. Certification and Survey Provider Enhanced Reports data from 2009 to 2015 are used to examine the effect of rurality on social service staffing using random-effects linear panel regressions. The average NH employed 1.8 full-time equivalents (FTEs), with approximately two thirds of social services staffed by QSWs. Large NHs had more staff, but employed fewer staff hours per resident day. Staffing levels were lower and QSWs made up a smaller percentage of staff in rural areas. National trends indicate variability in staffing by NH size and degree of rurality. Very low staffing within rural NHs is a concern, as staff may have less time to respond to residents' needs and these NHs may utilize fewer QSWs. © 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.

  18. The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure

    PubMed Central

    Giuliano, Karen K.; Danesh, Valerie; Funk, Marjorie

    2016-01-01

    OBJECTIVE The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. BACKGROUND Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. METHODS A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report “Best Hospitals” survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. RESULTS A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. CONCLUSION These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes. PMID:26579974

  19. 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.

  20. 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…

  1. 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.

  2. The effect of nurse staffing patterns on medical errors and nurse burnout.

    PubMed

    Garrett, Connie

    2008-06-01

    Hospital administrators frequently rely on the use of mandatory or voluntary overtime to cover staff nurse vacancies. This practice is common in the perioperative setting, but it can lead to staff-member fatigue that may adversely affect patient safety. This literature review explores the effect that nurse staffing patterns have on the frequency of medical errors, fatigue, and nurse burnout. The evidence indicates that inadequate nurse staffing leads to adverse patient outcomes and increased nurse burnout. Hospital administrators should invest in adequate nurse staffing to improve patient safety and increase nurse retention.

  3. Evidence-based staffing and "communityship" as the key to success.

    PubMed

    Kerfoot, Karlene; Douglas, Kathy

    2010-03-01

    Embracing an inclusive leadership style is the foundation of building an approach to staffing that maximizes outcomes for patients, the workforce, and the organizations in which care is delivered. By engaging everyone involved and inviting participation, a structure of shared understanding is created, providing an environment that is positioned to achieve optimal results. Communityship offers a model for approaching leadership that is aligned with leveraging talent across an organization and developing a culture prepared to face the complex challenges of staffing and achieving new levels of performance that an evidence-based approach to staffing excellence can offer. A zero-defect health care system can be achieved by developing communityship.

  4. Theory of stress fluctuations

    PubMed

    Wallace

    2000-09-01

    The current status of the theory of stress fluctuations is marked by two circumstances: no currently available formulas are valid for a metallic system, and a series of contradictory formulas remains unresolved. Here we derive formulas for shear- and isotropic-stress energy fluctuations, in the primary statistical mechanics ensembles. These formulas are valid for a classical monatomic system representing a metal or nonmetal, in cubic crystal, amorphous solid, or liquid phases. Current contradictions in fluctuation formulas are resolved through the following observations. First, the expansion of a dynamical variable A in terms of the fluctuations explicit in a given ensemble distribution, for example deltaA=adeltaN+bdeltaH in the grand canonical ensemble, is correct if and only if deltaA is a function only of deltaN and deltaH. The common use of this expansion has produced incorrect fluctuation formulas. Second, the thermodynamic fluctuations of Landau and Lifshitz do not correspond to statistical mechanics fluctuations, and the two types of fluctuations have essentially different values.

  5. Fluctuations in Proteins

    NASA Astrophysics Data System (ADS)

    Frauenfelder, Hans

    2007-03-01

    Proteins are the machines of life. In order to perform their functions, they must move continuously. The motions correspond to equilibrium fluctuations and to non-equilibrium relaxations. At least three different fluctuation processes occur: α- and β-fluctuations and processes that occur even below one Kelvin. The α-fluctuations can be approximated by the Vogel-Tammann-Fulcher relation, while the β-fluctuations appear to follow a conventional Arrhenius law (but may in some cases be better characterized by a Ferry law). Both are usually nonexponential in time. These phenomena are similar in proteins and glasses, but there is a fundamental difference between fluctuations in glasses and proteins: In glasses, they are independent of the environment, in proteins the α-fluctuations are slaved to the α-fluctuations in the solvent surrounding the protein; they follow their rate coefficients but they are entropically slowed. The studies of the protein motions are actually still in their infancy, but we can expect that future work will not only help understanding protein functions, but will also feed back to the physics of glasses.

  6. Revisiting detrended fluctuation analysis

    PubMed Central

    Bryce, R. M.; Sprague, K. B.

    2012-01-01

    Half a century ago Hurst introduced Rescaled Range (R/S) Analysis to study fluctuations in time series. Thousands of works have investigated or applied the original methodology and similar techniques, with Detrended Fluctuation Analysis becoming preferred due to its purported ability to mitigate nonstationaries. We show Detrended Fluctuation Analysis introduces artifacts for nonlinear trends, in contrast to common expectation, and demonstrate that the empirically observed curvature induced is a serious finite-size effect which will always be present. Explicit detrending followed by measurement of the diffusional spread of a signals' associated random walk is preferable, a surprising conclusion given that Detrended Fluctuation Analysis was crafted specifically to replace this approach. The implications are simple yet sweeping: there is no compelling reason to apply Detrended Fluctuation Analysis as it 1) introduces uncontrolled bias; 2) is computationally more expensive than the unbiased estimator; and 3) cannot provide generic or useful protection against nonstationaries. PMID:22419991

  7. Report: Congressionally Requested Report on EPA Staffing Levels and Total Costs for EPA Facilities

    EPA Pesticide Factsheets

    Report #09-P-0080, January 14, 2009. Additional information on the staffing levels, rental/lease fees, and utility and security costs for all of the EPA facilities and/or locations where EPA incurs costs associated with its employees.

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

    PubMed

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

    2013-12-01

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

  9. RN4CAST@IT-Ped: nurse staffing and children's safety.

    PubMed

    Sasso, Loredana; Bagnasco, Annamaria; Petralia, Paolo; Scelsi, Silvia; Zanini, Milko; Catania, Gianluca; Aleo, Giuseppe; Dasso, Nicoletta; Rossi, Silvia; Watson, Roger; Sermeus, Walter; Icardi, Giancarlo; Aiken, Linda H

    2017-09-27

    Some authors argue that it is not longer ethically correct to expose hospitalized patients to death risks associated with understaffing (Nickitas, 2014). Also the Care Quality Commission (CQC, an independent regulator of all health and social care services in England) has included staffing levels as one of the auditing quality standards when inspecting hospitals and health centres. The Royal College of Nursing, in its document Mandatory Nurse Staffing Levels (RCN, 2012), clearly defined which nurse staffing levels should be adopted by policy makers to ensure the provision of safe care. However, even in the UK where such pressure exists there are no legally defined nurse staffing levels. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  10. Multiple Staffing and Teacher Actions: The Effect of Team Teaching In Early Childhood Education.

    ERIC Educational Resources Information Center

    McNairy, Marion R.

    1988-01-01

    Studies the effects of multiple staffing in an early childhood classroom through the use of participant and classroom observation. Interpersonal relationships, territorial ownership, and differential status characteristics contributed to differential behavior of an educator. (RJC)

  11. Patient turnover and the relationship between nurse staffing and patient outcomes.

    PubMed

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

    2012-06-01

    High patient turnover (patient throughput generated by admissions, discharges, and transfers) contributes to increased demands and resources for care. We examined how the relationship between registered nurse (RN) staffing and failure-to-rescue (FTR) varied with patient turnover levels by analyzing quarterly data from the University HealthSystem Consortium. The data included 42 hospitals, representing 759 nursing units and about 1 million inpatients. Higher RN staffing was associated with lower FTR. When patient turnover increased from 48.6% to 60.7% on nonintensive units (non-ICUs), the beneficial effect of non-ICU RN staffing on FTR was reduced by 11.5%. RN staffing should be adjusted according to patient turnover because turnover increases patient care demand beyond that presented by patient count, and outcomes may be adversely affected. Copyright © 2012 Wiley Periodicals, Inc.

  12. 78 FR 28632 - Hutchinson Technology Inc. Including On-Site Leased Workers From Doherty Staffing Hutchinson...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-15

    ... Employment and Training Administration Hutchinson Technology Inc. Including On-Site Leased Workers From Doherty Staffing Hutchinson, Minnesota; Amended Certification Regarding Eligibility To Apply for Worker... Assistance on September 7, 2011, applicable to workers of Hutchinson Technology Inc., Hutchinson, Minnesota...

  13. 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

  14. Hadronic Correlations and Fluctuations

    SciTech Connect

    Koch, Volker

    2008-10-09

    We will provide a review of some of the physics which can be addressed by studying fluctuations and correlations in heavy ion collisions. We will discuss Lattice QCD results on fluctuations and correlations and will put them into context with observables which have been measured in heavy-ion collisions. Special attention will be given to the QCD critical point and the first order co-existence region, and we will discuss how the measurement of fluctuations and correlations can help in an experimental search for non-trivial structures in the QCD phase diagram.

  15. Spatial fluctuation theorem

    NASA Astrophysics Data System (ADS)

    Pérez-Espigares, Carlos; Redig, Frank; Giardinà, Cristian

    2015-08-01

    For non-equilibrium systems of interacting particles and for interacting diffusions in d-dimensions, a novel fluctuation relation is derived. The theorem establishes a quantitative relation between the probabilities of observing two current values in different spatial directions. The result is a consequence of spatial symmetries of the microscopic dynamics, generalizing in this way the Gallavotti-Cohen fluctuation theorem related to the time-reversal symmetry. This new perspective opens up the possibility of direct experimental measurements of fluctuation relations of vectorial observables.

  16. Continuous information flow fluctuations

    NASA Astrophysics Data System (ADS)

    Rosinberg, Martin Luc; Horowitz, Jordan M.

    2016-10-01

    Information plays a pivotal role in the thermodynamics of nonequilibrium processes with feedback. However, much remains to be learned about the nature of information fluctuations in small-scale devices and their relation with fluctuations in other thermodynamics quantities, like heat and work. Here we derive a series of fluctuation theorems for information flow and partial entropy production in a Brownian particle model of feedback cooling and extend them to arbitrary driven diffusion processes. We then analyze the long-time behavior of the feedback-cooling model in detail. Our results provide insights into the structure and origin of large deviations of information and thermodynamic quantities in autonomous Maxwell's demons.

  17. Variation in Residential Care Community Nurse and Aide Staffing Levels: United States, 2014.

    PubMed

    Rome, Vincent; Harris-Kojetin, Lauren D

    2016-02-19

    This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014. Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level. In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer’s disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide

  18. 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

  19. The role of health care technology in support of perinatal nurse staffing.

    PubMed

    Ivory, Catherine H

    2015-01-01

    Health care technology can generate massive amounts of data. However, when data are generated from disparate, uncoordinated systems, using them to make decisions related to staffing can be a challenge. In this article, I describe the importance of data standardization, system interoperability, standard terminologies that support nursing practice, and nursing informatics expertise as tools for improving the usefulness of electronic systems for informing staffing decisions. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  20. 38 CFR 58.10 - VA Form 10-3567-State Home Inspection Staffing Profile.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) FORMS § 58.10 VA Form 10-3567—State Home Inspection Staffing Profile. ER06JA00.000 ER06JA00.001...

  1. 38 CFR 58.10 - VA Form 10-3567-State Home Inspection Staffing Profile.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) FORMS § 58.10 VA Form 10-3567—State Home Inspection Staffing Profile. ER06JA00.000 ER06JA00.001...

  2. 38 CFR 58.10 - VA Form 10-3567-State Home Inspection Staffing Profile.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) FORMS § 58.10 VA Form 10-3567—State Home Inspection Staffing Profile. ER06JA00.000 ER06JA00.001...

  3. 38 CFR 58.10 - VA Form 10-3567-State Home Inspection Staffing Profile.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) FORMS § 58.10 VA Form 10-3567—State Home Inspection Staffing Profile. ER06JA00.000 ER06JA00.001...

  4. Incorporating nurse absenteeism into staffing with demand uncertainty.

    PubMed

    Maass, Kayse Lee; Liu, Boying; Daskin, Mark S; Duck, Mary; Wang, Zhehui; Mwenesi, Rama; Schapiro, Hannah

    2017-03-01

    Increased nurse-to-patient ratios are associated negatively with increased costs and positively with improved patient care and reduced nurse burnout rates. Thus, it is critical from a cost, patient safety, and nurse satisfaction perspective that nurses be utilized efficiently and effectively. To address this, we propose a stochastic programming formulation for nurse staffing that accounts for variability in the patient census and nurse absenteeism, day-to-day correlations among the patient census levels, and costs associated with three different classes of nursing personnel: unit, pool, and temporary nurses. The decisions to be made include: how many unit nurses to employ, how large a pool of cross-trained nurses to maintain, how to allocate the pool nurses on a daily basis, and how many temporary nurses to utilize daily. A genetic algorithm is developed to solve the resulting model. Preliminary results using data from a large university hospital suggest that the proposed model can save a four-unit pool hundreds of thousands of dollars annually as opposed to the crude heuristics the hospital currently employs.

  5. Intended and unintended consequences of minimum staffing standards for nursing homes.

    PubMed

    Chen, Min M; Grabowski, David C

    2015-07-01

    Staffing is the dominant input in the production of nursing home services. Because of concerns about understaffing in many US nursing homes, a number of states have adopted minimum staffing standards. Focusing on policy changes in California and Ohio, this paper examined the effects of minimum nursing hours per resident day regulations on nursing home staffing levels and care quality. Panel data analyses of facility-level nursing inputs and quality revealed that minimum staffing standards increased total nursing hours per resident day by 5% on average. However, because the minimum staffing standards treated all direct care staff uniformly and ignored indirect care staff, the regulation had the unintended consequences of both lowering the direct care nursing skill mix (i.e., fewer professional nurses relative to nurse aides) and reducing the absolute level of indirect care staff. Overall, the staffing regulations led to a reduction in severe deficiency citations and improvement in certain health conditions that required intensive nursing care. Copyright © 2014 John Wiley & Sons, Ltd.

  6. 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.

  7. 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

  8. [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.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. Nurses' perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units.

    PubMed

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

    2012-01-01

    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. 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." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. 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. 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. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  14. 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

  15. Scaling metabolic rate fluctuations

    PubMed Central

    Labra, Fabio A.; Marquet, Pablo A.; Bozinovic, Francisco

    2007-01-01

    Complex ecological and economic systems show fluctuations in macroscopic quantities such as exchange rates, size of companies or populations that follow non-Gaussian tent-shaped probability distributions of growth rates with power-law decay, which suggests that fluctuations in complex systems may be governed by universal mechanisms, independent of particular details and idiosyncrasies. We propose here that metabolic rate within individual organisms may be considered as an example of an emergent property of a complex system and test the hypothesis that the probability distribution of fluctuations in the metabolic rate of individuals has a “universal” form regardless of body size or taxonomic affiliation. We examined data from 71 individuals belonging to 25 vertebrate species (birds, mammals, and lizards). We report three main results. First, for all these individuals and species, the distribution of metabolic rate fluctuations follows a tent-shaped distribution with power-law decay. Second, the standard deviation of metabolic rate fluctuations decays as a power-law function of both average metabolic rate and body mass, with exponents −0.352 and −1/4 respectively. Finally, we find that the distributions of metabolic rate fluctuations for different organisms can all be rescaled to a single parent distribution, supporting the existence of general principles underlying the structure and functioning of individual organisms. PMID:17578913

  16. 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.

  17. 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.

  18. Staffing Higher Education: Meeting New Challenges. Report of the IMHE Project on Policies for Academic Staffing in Higher Education. Higher Education Policy Series 27.

    ERIC Educational Resources Information Center

    Kogan, Maurice; And Others

    This volume uses recent research in the United States, Canada, Australia, and United Kingdom and other nations to articulate the issues of faculty recruitment, training, rewards and employment in higher education. Chapter 1 looks at staffing as a policy issue. Chapter 2 explores how the academic profession is changing and touches on access to…

  19. Et Tu, Educator, Differentiated Staffing? Rationale and Model for a Differentiated Teaching Staff. TEPS Write-in Papers on Flexible Staffing Patterns, No. 4.

    ERIC Educational Resources Information Center

    English, Fenwick

    In developing a rationale for the reorganization of educational institutions, the author examines the fallacies inherent in current organizational practice and discusses the potential advantaged of differentiated staffing, particularly in terms of improved teacher morale, increased teacher effectiveness, and decreased teacher turnover. He presents…

  20. The challenges of staffing urban schools with effective teachers.

    PubMed

    Jacob, Brian A

    2007-01-01

    Brian Jacob examines challenges faced by urban districts in staffing their schools with effective teachers. He emphasizes that the problem is far from uniform. Teacher shortages are more severe in certain subjects and grades than others, and differ dramatically from one school to another. The Chicago public schools, for example, regularly receive roughly ten applicants for each teaching position. But many applicants are interested in specific schools, and district officials struggle to find candidates for highly impoverished schools. Urban districts' difficulty in attracting and hiring teachers, says Jacob, means that urban teachers are less highly qualified than their suburban counterparts with respect to characteristics such as experience, educational background, and teaching certification. But they may not thus be less effective teachers. Jacob cites recent studies that have found that many teacher characteristics bear surprisingly little relationship to student outcomes. Policies to enhance teacher quality must thus be evaluated in terms of their effect on student achievement, not in terms of conventional teacher characteristics. Jacob then discusses how supply and demand contribute to urban teacher shortages. Supply factors involve wages, working conditions, and geographic proximity between teacher candidates and schools. Urban districts have tried various strategies to increase the supply of teacher candidates (including salary increases and targeted bonuses) and to improve retention rates (including mentoring programs). But there is little rigorous research evidence on the effectiveness of these strategies. Demand also has a role in urban teacher shortages. Administrators in urban schools may not recognize or value high-quality teachers. Human resource departments restrict district officials from making job offers until late in the hiring season, after many candidates have accepted positions elsewhere. Jacob argues that urban districts must improve hiring

  1. Revisiting the relationship between nurse staffing and quality of care in nursing homes: an instrumental variables approach.

    PubMed

    Lin, Haizhen

    2014-09-01

    This paper revisits the relationship between nurse staffing and quality of care in nursing homes using an instrumental variables approach. Most prior studies rely on cross-sectional evidence, which renders causal inference problematic and policy recommendations inappropriate. We exploit legislation changes regarding minimum staffing requirements in eight states between 2000 and 2001 as exogenous shocks to nurse staffing levels. We find that registered nurse staffing has a large and significant impact on quality of care, and that there is no evidence of a significant association between nurse aide staffing and quality of care. A comparison of the IV estimation to the OLS estimation of the first-difference model suggests that ignoring endogeneity would lead to an underestimation of how nurse staffing affects quality of care in nursing homes. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality.

    PubMed

    He, Jianghua; Staggs, Vincent S; Bergquist-Beringer, Sandra; Dunton, Nancy

    2016-01-01

    Time trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient outcomes in recent years. It is unknown whether these changes were associated. Quarterly unit-level nursing data in 2004-2012 were extracted from the National Database of Nursing Quality Indicators® (NDNQI®). Units were divided into groups based on patterns of missing data. All variables were aggregated across units within these groups and analyses were conducted at the group level. Patient outcomes included rates of inpatient falls and hospital-acquired pressure ulcers. Staffing variables included total nursing hours per patient days (HPPD) and percent of nursing hours provided by registered nurses (RN skill-mix). Weighted linear mixed models were used to examine the associations between nurse staffing and patient outcomes at trend and seasonal levels. At trend level, both staffing variables were inversely associated with all outcomes (p < 0.001); at seasonal level, total HPPD was inversely associated (higher staffing related to lower event rate) with all outcomes (p < 0.001) while RN skill-mix was positively associated (higher staffing related to higher event rate) with fall rate (p < 0.001) and pressure ulcer rate (p = 0.03). It was found that total HPPD tended to be lower and RN skill-mix tended to be higher in Quarter 1 (January-March) when falls and pressure ulcers were more likely to happen. By aggregating data across units we were able to detect associations between nurse staffing and patient outcomes at both trend and seasonal levels. More rigorous research is needed to study the underlying mechanism of these associations.

  3. 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.

  4. The association between nurse staffing and hospital outcomes in injured patients

    PubMed Central

    2012-01-01

    Background The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. Methods We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region). Results A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p < 0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing. Conclusions Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers. PMID:22876839

  5. Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?

    PubMed

    Van den Heede, Koen; Simoens, Steven; Diya, Luwis; Lesaffre, Emmanuel; Vleugels, Arthur; Sermeus, Walter

    2010-06-01

    This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.

  6. Fluctuating shells under pressure

    PubMed Central

    Paulose, Jayson; Vliegenthart, Gerard A.; Gompper, Gerhard; Nelson, David R.

    2012-01-01

    Thermal fluctuations strongly modify the large length-scale elastic behavior of cross-linked membranes, giving rise to scale-dependent elastic moduli. Whereas thermal effects in flat membranes are well understood, many natural and artificial microstructures are modeled as thin elastic shells. Shells are distinguished from flat membranes by their nonzero curvature, which provides a size-dependent coupling between the in-plane stretching modes and the out-of-plane undulations. In addition, a shell can support a pressure difference between its interior and its exterior. Little is known about the effect of thermal fluctuations on the elastic properties of shells. Here, we study the statistical mechanics of shape fluctuations in a pressurized spherical shell, using perturbation theory and Monte Carlo computer simulations, explicitly including the effects of curvature and an inward pressure. We predict novel properties of fluctuating thin shells under point indentations and pressure-induced deformations. The contribution due to thermal fluctuations increases with increasing ratio of shell radius to thickness and dominates the response when the product of this ratio and the thermal energy becomes large compared with the bending rigidity of the shell. Thermal effects are enhanced when a large uniform inward pressure acts on the shell and diverge as this pressure approaches the classical buckling transition of the shell. Our results are relevant for the elasticity and osmotic collapse of microcapsules. PMID:23150558

  7. Staffing in acute hospital wards: part 2. Relationships between grade mix, staff stability and features of ward organizational environment.

    PubMed

    Adams, Ann; Bond, Senga

    2003-09-01

    This paper explores relationships between grade mix, staff stability, care organization and nursing practice. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Analyses provides important insights for managers seeking to achieve the strategic aims set out in consecutive National Health Service (NHS) human resource management policies. Hypotheses about ward clinical grade mix were not well supported. Where there was rich grade mix, nurses reported better collaborative working with other disciplines and greater influence. However, it was expected that wards practising 'devolved' nursing would have a richer grade mix and that the latter would lead to more innovative practice and nurses experiencing greater job satisfaction. No evidence to support any of these hypotheses was found although the opposite scenario - a link between poor grade mix, unprogressive practice and perceived lower standards of care - was supported. Wards practising the 'devolved' system rely on adequate numbers of nurses rather than a rich grade mix, and do not necessarily provide a more stable, retentive work environment for nurses. By contrast, findings about staff stability were largely as expected. A strong link between staff stability and standards of professional nursing practice was found, indicating that staff stability is more important than a rich grade mix for achieving innovative, research-based practice. However, staff instability undermined cohesion with nurse colleagues, collaborative working with doctors, and nurses' ability to cope with the workload. Overall, both the papers demonstrate that staffing resources and prevailing ethos of care are more important predictors of care processes and job satisfaction than organizational systems. They identify the detrimental effects on nurses and their work of having few staff and a weak grade mix, and the importance of staff stability. Higher standards of nursing

  8. 77 FR 19719 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, IBM...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-02

    ... Solutions TEC Staffing, IBM Corporation, TEK Systems Penske Logistics, Eurest, Canteen, Kelly Services, Inc..., Eurest, Canteen, Kelly Services, Inc., Prodriver, Arkansas Warehouse, Inc., and Andrews...

  9. 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.

  10. Turbulent magnetohydrodynamic density fluctuations

    NASA Technical Reports Server (NTRS)

    Shebalin, John V.; Montgomery, David

    1988-01-01

    A spectral-method numerical code is used to compute mass-density fluctuation spectra in turbulent magnetofluids. The computations are used to test and extend the analytical theory of density variations in slightly compressible magnetofluids given by Montgomery, et al. (1987) and used to infer inertial-range density-fluctuation spectra for the nearby interstellar medium and solar wind. A local equation of state is assumed, relating density to pressure. Constant, scalar resistivities and viscosities are used. In the limit of low Mach numbers and high mechanical-to-magnetic pressure ratios, the fit of the computations to the analytical theory is seen to be close.

  11. Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand.

    PubMed

    Nantsupawat, Apiradee; Nantsupawat, Raymoul; Kulnaviktikul, Wipada; McHugh, Matthew D

    2014-04-04

    A growing body of research has shown an association between nurse staffing levels and a range of nurse outcomes. There is little empirical research evaluating this relationship in Thailand. This study evaluated the influence of nurse staffing levels on outcomes among nurses. A cross-sectional survey design was conducted at 92 community hospitals using a stratified random sampling design across Thailand during May and July 2012. Questionnaires included items focusing on nurse staffing levels; job dissatisfaction and emotional exhaustion, both related to nurse retention; and needlestick and sharps injuries. The study sample comprised 1412 registered nurses who provided direct patient care. The findings showed that each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job; 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needlestick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse outcomes. Nurses are significant healthcare providers that directly affect quality of care and patient safety in hospitals. Improvement of nurse staffing levels holds promise for improving nurse outcomes in Thailand. © 2014 Wiley Publishing Asia Pty Ltd.

  12. Determining staffing requirements for blood donor clinics: the Canadian Blood Services experience.

    PubMed

    Blake, John T; Shimla, Susan

    2014-03-01

    Canadian Blood Services runs approximately 16,000 donor clinics annually. While there were more than 220 different clinic configurations used in 2011 and 2012, 67% of all clinic configurations followed one of 51 standard models. As part of operational planning for current and future configurations it was necessary for Canadian Blood Services to calculate staffing requirements for standard clinic models. In this article we present a method that incorporates both cost control and impact on donor experience. We calculate staffing requirements to minimize costs, but adjust using queuing theory to ensure donor wait time metrics are met. The method can be applied in a wide variety of situations. Although developed for a particular study, the methods described in this article can be applied in a wide variety of situations. A case study in which the model is used to review existing staffing arrangements at Canadian Blood Services is presented. The staffing model can be used to balance the requirements of minimizing staffing costs with that of ensuring that donors do not suffer unnecessary delays. Moreover, in an example application, savings of 3.4% were identified through the modeling process. © 2013 American Association of Blood Banks.

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

    PubMed Central

    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 levels and deficiency citations for 663 Florida nursing homes between 2002 and 2005. Using a generalized estimating equation approach in SAS Proc Genmod, we estimate the relationship between CNA and licensed nursing staff, and facilities’ total deficiency score and quality of care deficiency scores—calculated using the Centers for Medicare and Medicaid Services’ Nursing Home Compare Five-Star Quality Rating System, which accounts for the complexity of the scope and severity of the cittions. Results: Our results confirmed that higher CNA staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores after controlling for facility characteristics. Conclusion: With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality. PMID:21602292

  14. The influence of nurse staffing levels on quality of care in nursing homes.

    PubMed

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

    2011-10-01

    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. Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing levels and deficiency citations for 663 Florida nursing homes between 2002 and 2005. Using a generalized estimating equation approach in SAS Proc Genmod, we estimate the relationship between CNA and licensed nursing staff, and facilities' total deficiency score and quality of care deficiency scores-calculated using the Centers for Medicare and Medicaid Services' Nursing Home Compare Five-Star Quality Rating System, which accounts for the complexity of the scope and severity of the cittions. Our results confirmed that higher CNA staffing levels were predictors of lower total deficiency scores and quality of care deficiency scores after controlling for facility characteristics. With a large sample size, repeated measure design, and advanced methods, we have found a relationship between CNA staffing and nursing home quality.

  15. Toward cost-effective staffing mixes for Veterans Affairs substance use disorder treatment programs.

    PubMed

    Im, Jinwoo J; Shachter, Ross D; Finney, John W; Trafton, Jodie A

    2015-11-23

    In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically. We used a stepwise method to derive prediction functions for benefits and costs based on patients' treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping. Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients' outcomes, and improved net benefits are estimated from $1472 to $17,743 per patient.

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

    PubMed

    Kirby, Esther; Hurst, Keith

    2014-05-01

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

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

    PubMed

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

    2014-03-01

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

  18. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363 Special...

  19. 5 CFR 9701.363 - Special staffing payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363...

  20. Nurse Staffing Calculation in the Emergency Department - Performance-Oriented Calculation Based on the Manchester Triage System at the University Hospital Bonn.

    PubMed

    Gräff, Ingo; Goldschmidt, Bernd; Glien, Procula; Klockner, Sophia; Erdfelder, Felix; Schiefer, Jennifer Lynn; Grigutsch, Daniel

    2016-01-01

    To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe. Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS), taking into account specific workload fluctuations (50th-95th percentiles). Patients classified to the MTS category red (n = 35) required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118), nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181), 40.95 min, while the two MTS categories with the least acute patients, green (n = 129) and blue (n = 40) required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010) emergency patients, 67-123 emergency patients (50-95% percentile) per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1. Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.

  1. A comparison between reported therapy staffing levels and the department of health therapy staffing guidelines for stroke rehabilitation: a national survey

    PubMed Central

    2014-01-01

    Background This study compared reported staffing levels for stroke care within UK in-patient stroke units to stroke strategy staffing guidelines published by the UK Department of Health and the Royal College of Physicians. The purpose was to explore the extent to which stroke teams are meeting recommended staffing levels. Method The data analyzed in this report consisted of the detailed therapist staffing levels reported in the demographic section of our national survey to determine upper limb treatment in stroke units (the ATRAS survey). A contact list of stroke practitioners was therefore compiled primarily in collaboration with the 28 National Stroke Improvement Networks. Geographic representation of the network areas was obtained by applying the straight-forward systematic sampling method and the Nth name selection technique to each Network list. In total 192 surveys were emailed to stroke care providers around England. This included multiple contacts within stroke teams (e.g. a stroke consultant and a stroke co-coordinator) to increase awareness of the survey. Results A total of 53 surveys were returned from stroke teams and represented 20 of the 28 network areas providing 71% national coverage. To compare reported staffing levels to suggested DoH guidelines, analysis was conducted on 19 of the 37 inpatient hospital care units that had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and average unit occupancy rates. Only 42% of units analyzed reached the DoH guideline for physiotherapy and fewer than 16% of the units reached the guideline for speech & language therapy. By contrast, 84% of units surveyed reached the staffing guideline for occupational therapy. However, a post-hoc analysis highlights this as an irregularity in the DoH guidelines, revealing that all therapies are challenged to provide the recommended therapy time. Conclusions Most in-patient stroke units are operating

  2. GRADFLEX: Fluctuations in Microgravity

    NASA Technical Reports Server (NTRS)

    Vailati, A.; Cerbino, R.; Mazzoni, S.; Giglio, M.; Nikolaenko, G.; Cannell, D. S.; Meyer, W. V.; Smart, A. E.

    2004-01-01

    We present the results of experimental investigations of gradient driven fluctuations induced in a liquid mixture with a concentration gradient and in a single-component fluid with a temperature gradient. We also describe the experimental apparatus being developed to carry out similar measurement under microgravity conditions.

  3. Fluctuating transport in microstructures

    SciTech Connect

    Xie, X.

    1988-01-01

    In this dissertation, we study electronic transport properties of various kinds of quasi-one dimensional (Q1D) systems. The dissertation can be divided into the following categories: (1) Conductance fluctuations and phase coherence in microstructures. We study the conductance fluctuations for three different regimes of electronic transport: ballistic, diffusive and variable-range-hopping (VRH). Various numerical methods are used in the calculations. In the VRH problem, we also examine the possibility of observing the Aharonov-Bohm effect. We develop a technique based on the recursive Kubo formula to study the universal conductance fluctuations in the diffusive regime. Close comparison with relevant experiments is made and good agreement is found. (2) Drude transport properties of quasi-one dimensional systems. In this problem, we calculate the density of states and Drude conductivity for the screened impurity scattering using many body theory. The DOS and conductivity show strong oscillatory behavior as a function of the Fermi-energy. Self-consistency is included in our theory. Good agreement with experiment is found. (3) Transport in quasicrystals. In solving this problem we use the Landauer formula approach. We find that the electrical resistance of a finite 1D Fibonacci-sequence quasicrystal shows strong fluctuations as resonant tunneling occurs through the allowed energy states of the system. Power law localization and self-similarity can be seen in the transport properties. A possible experiment to observe this phenomenon is suggested.

  4. Nonequilibrium mesoscopic conductance fluctuations

    NASA Astrophysics Data System (ADS)

    Ludwig, T.; Blanter, Ya. M.; Mirlin, A. D.

    2004-12-01

    We investigate the amplitude of mesoscopic fluctuations of the differential conductance of a metallic wire at arbitrary bias voltage V . For noninteracting electrons, the variance ⟨δg2⟩ increases with V . The asymptotic large- V behavior is ⟨δg2⟩˜V/Vc (where eVc=D/L2 is the Thouless energy), in agreement with the earlier prediction by Larkin and Khmelnitskii. We find, however, that this asymptotics has a very small numerical prefactor and sets in at very large V/Vc only, which strongly complicates its experimental observation. This high-voltage behavior is preceded by a crossover regime, V/Vc≲30 , where the conductance variance increases by a factor ˜3 as compared to its value in the regime of universal conductance fluctuations (i.e., at V→0 ). We further analyze the effect of dephasing due to the electron-electron scattering on ⟨δg2⟩ at high voltages. With the Coulomb interaction taken into account, the amplitude of conductance fluctuations becomes a nonmonotonic function of V . Specifically, ⟨δg2⟩ drops as 1/V for voltages V≫gVc , where g is the dimensionless conductance. In this regime, the conductance fluctuations are dominated by quantum-coherent regions of the wire adjacent to the reservoirs.

  5. Active fluctuation symmetries

    NASA Astrophysics Data System (ADS)

    Maes, Christian; Salazar, Alberto

    2014-01-01

    In contrast with the understanding of fluctuation symmetries for entropy production, similar ideas applied to the time-symmetric fluctuation sector have been less explored. Here we give detailed derivations of time-symmetric fluctuation symmetries in boundary-driven particle systems such as the open Kawasaki lattice gas and the zero-range model. As a measure of time-symmetric dynamical activity over time T we count the difference (Nℓ - Nr)/T between the number of particle jumps in or out at the left edge and those at the right edge of the system. We show that this quantity satisfies a fluctuation symmetry from which we derive a new Green-Kubo-type relation. It will follow then that the system is more active at the edge connected to the particle reservoir with the largest chemical potential. We also apply these exact relations derived for stochastic particle models to a deterministic case, the spinning Lorentz gas, where the symmetry relation for the activity is checked numerically.

  6. Fluctuating Asymmetry and Intelligence

    ERIC Educational Resources Information Center

    Bates, Timothy C.

    2007-01-01

    The general factor of mental ability ("g") may reflect general biological fitness. If so, "g"-loaded measures such as Raven's progressive matrices should be related to morphological measures of fitness such as fluctuating asymmetry (FA: left-right asymmetry of a set of typically left-right symmetrical body traits such as finger…

  7. 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.

  8. Terrestrial Gravity Fluctuations

    NASA Astrophysics Data System (ADS)

    Harms, Jan

    2015-12-01

    Different forms of fluctuations of the terrestrial gravity field are observed by gravity experiments. For example, atmospheric pressure fluctuations generate a gravity-noise foreground in measurements with super-conducting gravimeters. Gravity changes caused by high-magnitude earthquakes have been detected with the satellite gravity experiment GRACE, and we expect high-frequency terrestrial gravity fluctuations produced by ambient seismic fields to limit the sensitivity of ground-based gravitational-wave (GW) detectors. Accordingly, terrestrial gravity fluctuations are considered noise and signal depending on the experiment. Here, we will focus on ground-based gravimetry. This field is rapidly progressing through the development of GW detectors. The technology is pushed to its current limits in the advanced generation of the LIGO and Virgo detectors, targeting gravity strain sensitivities better than 10-23 Hz-1/2 above a few tens of a Hz. Alternative designs for GW detectors evolving from traditional gravity gradiometers such as torsion bars, atom interferometers, and superconducting gradiometers are currently being developed to extend the detection band to frequencies below 1 Hz. The goal of this article is to provide the analytical framework to describe terrestrial gravity perturbations in these experiments. Models of terrestrial gravity perturbations related to seismic fields, atmospheric disturbances, and vibrating, rotating or moving objects, are derived and analyzed. The models are then used to evaluate passive and active gravity noise mitigation strategies in GW detectors, or alternatively, to describe their potential use in geophysics. The article reviews the current state of the field, and also presents new analyses especially with respect to the impact of seismic scattering on gravity perturbations, active gravity noise cancellation, and time-domain models of gravity perturbations from atmospheric and seismic point sources. Our understanding of

  9. Terrestrial Gravity Fluctuations.

    PubMed

    Harms, Jan

    2015-01-01

    Different forms of fluctuations of the terrestrial gravity field are observed by gravity experiments. For example, atmospheric pressure fluctuations generate a gravity-noise foreground in measurements with super-conducting gravimeters. Gravity changes caused by high-magnitude earthquakes have been detected with the satellite gravity experiment GRACE, and we expect high-frequency terrestrial gravity fluctuations produced by ambient seismic fields to limit the sensitivity of ground-based gravitational-wave (GW) detectors. Accordingly, terrestrial gravity fluctuations are considered noise and signal depending on the experiment. Here, we will focus on ground-based gravimetry. This field is rapidly progressing through the development of GW detectors. The technology is pushed to its current limits in the advanced generation of the LIGO and Virgo detectors, targeting gravity strain sensitivities better than 10(-23) Hz(-1/2) above a few tens of a Hz. Alternative designs for GW detectors evolving from traditional gravity gradiometers such as torsion bars, atom interferometers, and superconducting gradiometers are currently being developed to extend the detection band to frequencies below 1 Hz. The goal of this article is to provide the analytical framework to describe terrestrial gravity perturbations in these experiments. Models of terrestrial gravity perturbations related to seismic fields, atmospheric disturbances, and vibrating, rotating or moving objects, are derived and analyzed. The models are then used to evaluate passive and active gravity noise mitigation strategies in GW detectors, or alternatively, to describe their potential use in geophysics. The article reviews the current state of the field, and also presents new analyses especially with respect to the impact of seismic scattering on gravity perturbations, active gravity noise cancellation, and time-domain models of gravity perturbations from atmospheric and seismic point sources. Our understanding of

  10. State of the science: the relationship between nurse staffing and patient outcomes.

    PubMed

    Brennan, Caitlin W; Daly, Barbara J; Jones, Katherine R

    2013-07-01

    Over a decade of research on the relationship between nurse staffing and patient outcomes has demonstrated the important role of nurses in the provision of high-quality, safe care, yet currently, no evidence-based nurse staffing guidelines exist. A systematic review of reviews was conducted to explore reasons why this is the case and recommend directions for future research to improve upon this gap. Authors of the 29 included reviews reported variability in methods and measurement approaches, lack of incorporation of nurse processes and system factors that potentially affect relationships among variables, and overall inconsistencies in results across primary studies. We propose use of an Integrated Framework for a Systems Approach to Nurse Staffing Research to inform the development of applicable conceptual models. Future studies that use a systems approach and focus on establishing causal relationships among variables will potentially strengthen the evidence and advance the science in this area.

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

    PubMed Central

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

    1989-01-01

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

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

    PubMed Central

    Logani, Sachin; Green, Adam; Gasperino, James

    2011-01-01

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

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

    PubMed

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

    2015-01-01

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

  14. Effect of increased nursing home hospice use on nursing assistant staffing.

    PubMed

    Tyler, Denise A; Leland, Natalie; Lepore, Michael; Miller, Susan C

    2011-11-01

    Since 1999, there has been a significant increase in hospice providers and hospice use in nursing homes. A 1997 Office of Inspector General (OIG) report warned of possible kickbacks, monetary and otherwise, that might be paid by hospices to nursing homes in exchange for referrals. One possible kickback mentioned in the report was nursing homes receiving additional staff hours at no cost, which could lead to decreases in nursing home staffing. The purpose of this study was to determine if changes in nursing home hospice volume were related to changes in certified nursing assistant (CNA) staffing. The study included free-standing nursing homes with at least 3 years of observation between 1999 and 2006, no fewer than five deaths in any year, and between 30 and 500 beds (n=10,759). We examined the longitudinal relationship between changing hospice volume and CNA minutes per resident day (MPRD), utilizing nursing home fixed-effects regression analysis and adjusting for resident case mix and changing organizational characteristics. The introduction of hospice services in a nursing home did not result in statistically significant changes in CNA staffing. Instead, increases in hospice volume resulted in small increases in CNA staffing. Specifically, the addition of 1000 hospice days, in a given year, resulted in an additional 0.79 (95% confidence interval [CI] 0.373-1.211) CNA MPRD. The proposition that nursing homes may be decreasing their staffing as a result of receiving additional hospice staff was not supported by this study and, in fact, nursing homes were found to only slightly increase CNA staffing with increasing hospice volume.

  15. Trends in Postacute Care and Staffing in US Nursing Homes, 2001–2010

    PubMed Central

    Tyler, Denise A.; Feng, Zhanlian; Leland, Natalie E.; Gozalo, Pedro; Intrator, Orna; Mor, Vincent

    2013-01-01

    Objective The objective of this study was to document the growth of postacute care and contemporaneous staffing trends in US nursing homes over the decade 2001 to 2010. Design We integrated data from all US nursing homes longitudinally to track annual changes in the levels of postacute care intensity, therapy staffing and direct-care staffing separately for freestanding and hospital-based facilities. Setting All Medicare/Medicaid-certified nursing homes from 2001 to 2010 based on the Online Survey Certification and Reporting System database merged with facility-level case mix measures aggregated from resident-level information from the Minimum Data Set and Medicare Part A claims. Measurements We created a number of aggregate case mix measures to approximate the intensity of postacute care per facility per year, including the proportion of SNF-covered person days, number of admissions per bed, and average RUG-based case mix index. We also created measures of average hours per resident day for physical and occupational therapists, PT/OT assistants, PT/OT aides, and direct-care nursing staff. Results In freestanding nursing homes, all postacute care intensity measures increased considerably each year throughout the study period. In contrast, in hospital-based facilities, all but one of these measures decreased. Similarly, therapy staffing has risen substantially in freestanding homes but declined in hospital-based facilities. Postacute care case mix acuity appeared to correlate reasonably well with therapy staffing levels in both types of facilities. Conclusion There has been a marked and steady shift toward postacute care in the nursing home industry in the past decade, primarily in freestanding facilities, accompanied by increased therapy staffing. PMID:23810390

  16. Effects of nurse staffing ratios on patient mortality in Taiwan acute care hospitals: a longitudinal study.

    PubMed

    Liang, Yia-Wun; Tsay, Shwu-Feng; Chen, Wen-Yi

    2012-03-01

    The nurse workload in Taiwan averages two to seven times more than that in the United States and other developed countries. Previous studies have indicated heavy nursing workload as an underlying cause of preventable patient death. No studies have yet explored the relationship between nurse staffing ratio and patient mortality in Taiwan. This study explored the effect of nurse staffing ratios on patient mortality in acute care hospitals in Taiwan and considered the implications in terms of policy. Using stratified random sampling, 108 hospital nursing units in 32 of Taiwan's 441 accredited Western medicine district/regional hospitals and medical centers were included in the study. Variables were retrospectively measured from 108 wards by using monthly data during a 7-month period. A generalized estimating equation logistic model was used to obtain more precise estimates of the nurse staffing effect by controlling for hospital characteristic and patient acuity variables. The population-averaged odds ratio for the incidence of death between the low and high patient-nurse ratio groups was 3.617 (95% CI = [1.930, 6.776]). The risk of death in the high patient-nurse ratio group was significantly higher than in the low patient-nurse ratio group. Nurse staffing levels affect patient outcomes. Faced with the problem of inadequate nurses for hospital healthcare needs, Taiwanese policymakers should work to implement a legislatively mandated minimum patient-nurse ratio on a shift-by-shift basis to regulate nurse staffing. In setting guidelines for nurse staffing, policymakers must consider nursing staff characteristics in addition to the number of nurses.

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

    PubMed

    Shin, Juh Hyun; Hyun, Ta Kyung

    2015-11-01

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

  18. Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study.

    PubMed

    Staggs, Vincent S; Olds, Danielle M; Cramer, Emily; Shorr, Ronald I

    2017-01-01

    Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units. To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use. We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit's average staffing across study quarters. 3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006-2010. Units had to report at least one quarter with restraint use and one quarter without. We studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention. Nursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3-29 %) and 18 % (95 % CI: 8-29 %) higher for quarters with very low skill mix. In this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.

  19. Effect of Increased Nursing Home Hospice Use on Nursing Assistant Staffing

    PubMed Central

    Leland, Natalie; Lepore, Michael; Miller, Susan C.

    2011-01-01

    Abstract Background Since 1999, there has been a significant increase in hospice providers and hospice use in nursing homes. A 1997 Office of Inspector General (OIG) report warned of possible kickbacks, monetary and otherwise, that might be paid by hospices to nursing homes in exchange for referrals. One possible kickback mentioned in the report was nursing homes receiving additional staff hours at no cost, which could lead to decreases in nursing home staffing. The purpose of this study was to determine if changes in nursing home hospice volume were related to changes in certified nursing assistant (CNA) staffing. Methods The study included free-standing nursing homes with at least 3 years of observation between 1999 and 2006, no fewer than five deaths in any year, and between 30 and 500 beds (n=10,759). We examined the longitudinal relationship between changing hospice volume and CNA minutes per resident day (MPRD), utilizing nursing home fixed-effects regression analysis and adjusting for resident case mix and changing organizational characteristics. Results The introduction of hospice services in a nursing home did not result in statistically significant changes in CNA staffing. Instead, increases in hospice volume resulted in small increases in CNA staffing. Specifically, the addition of 1000 hospice days, in a given year, resulted in an additional 0.79 (95% confidence interval [CI] 0.373–1.211) CNA MPRD. Conclusions The proposition that nursing homes may be decreasing their staffing as a result of receiving additional hospice staff was not supported by this study and, in fact, nursing homes were found to only slightly increase CNA staffing with increasing hospice volume. PMID:21958012

  20. Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals.

    PubMed

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

    2011-04-01

    Nurse staffing has been linked to hospital patient outcomes; however, previous results were inconsistent because of variations in measures of staffing and were only rarely specific to types of patient care units. To determine the relationship between nurse staffing in general and intensive care units and patient outcomes and determine whether safety net status affects this relationship. A cross-sectional design used data from hospitals belonging to the University HealthSystem Consortium. Data were available for approximately 1.1 million adult patient discharges and staffing for 872 patient care units from 54 hospitals. Total hours of nursing care [Registered Nurses (RNs), Licensed Practical Nurses, and assistants] determined per inpatient day (TotHPD) and RN skill mix were the measures of staffing; Agency for Healthcare Research and Quality risk-adjusted safety and quality indicators were the outcome measures. TotHPD in general units was associated with lower rates of congestive heart failure mortality (P<0.05), failure to rescue (P<0.10), infections (P<0.01), and prolonged length of stay (P<0.01). RN skill mix in general units was associated with reduced failure to rescue (P<0.01) and infections (P<0.05). TotHPD in intensive care units was associated with fewer infections (P<0.05) and decubitus ulcers (P<0.10). RN skill mix was associated with fewer cases of sepsis (P<0.01) and failure to rescue (P<0.05). Safety-net status was associated with higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue. Higher nurse staffing protected patients from poor outcomes; however, hospital safety-net status introduced complexities in this relationship.

  1. Interim results of the study of control room crew staffing for advanced passive reactor plants

    SciTech Connect

    Hallbert, B.P.; Sebok, A.; Haugset, K.

    1996-03-01

    Differences in the ways in which vendors expect the operations staff to interact with advanced passive plants by vendors have led to a need for reconsideration of the minimum shift staffing requirements of licensed Reactor Operators and Senior Reactor Operators contained in current federal regulations (i.e., 10 CFR 50.54(m)). A research project is being carried out to evaluate the impact(s) of advanced passive plant design and staffing of control room crews on operator and team performance. The purpose of the project is to contribute to the understanding of potential safety issues and provide data to support the development of design review guidance. Two factors are being evaluated across a range of plant operating conditions: control room crew staffing; and characteristics of the operating facility itself, whether it employs conventional or advanced, passive features. This paper presents the results of the first phase of the study conducted at the Loviisa nuclear power station earlier this year. Loviisa served as the conventional plant in this study. Data collection from four crews were collected from a series of design basis scenarios, each crew serving in either a normal or minimum staffing configuration. Results of data analyses show that crews participating in the minimum shift staffing configuration experienced significantly higher workload, had lower situation awareness, demonstrated significantly less effective team performance, and performed more poorly as a crew than the crews participating in the normal shift staffing configuration. The baseline data on crew configurations from the conventional plant setting will be compared with similar data to be collected from the advanced plant setting, and a report prepared providing the results of the entire study.

  2. Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units.

    PubMed

    Cho, Sung-Hyun; June, Kyung Ja; Kim, Yun Mi; Cho, Yong Ae; Yoo, Cheong Suk; Yun, Sung-Cheol; Sung, Young Hee

    2009-06-01

    To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes. Nurse staffing has been reported to influence patient and nurse outcomes. A cross-sectional study with a survey conducted August-October 2007. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes. The average patient-to-nurse ratio was 2.8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3.26; 95% confidence interval, 1.14-9.31) or 2.0-2.5 patients (odds ratio, 2.44; 95% confidence interval, 1.32-4.52), compared with having more than three patients. Perceived adequate staffing was related to a threefold increase (odds ratio, 2.97; 95% confidence interval, 2.22-3.97) in the odds of nurses' rating high quality and decreases in the odds of dissatisfaction (odds ratio, 0.30; 95% confidence interval, 0.23-0.40), burnout (odds ratio, 0.50; 95% confidence interval, 0.34-0.73) and plan to leave (odds ratio, 0.40; 95% confidence interval, 0.28-0.56). Nurse staffing was associated with quality of care and job outcomes in the context of Korean intensive care units. Adequate staffing must be assured to achieve better quality of care and job outcomes.

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

    PubMed

    Al-Kandari, Fatimah; Thomas, Deepa

    2008-08-01

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

  4. Conductance fluctuations in nanostructures

    NASA Astrophysics Data System (ADS)

    Zhu, Ningjia

    1997-12-01

    In this Ph.D thesis the conductance fluctuations of different physical origins in semi-conductor nanostructures were studied using both diagrammatic analytical methods and large scale numerical techniques. In the "mixed" transport regime where both mesoscopic and ballistic features play a role, for the first time I have analytically calculated the non-universal conductance fluctuations. This mixed regime is reached when impurities are distributed near the walls of a quantum wire, leaving the center region ballistic. I have discovered that the existence of a ballistic region destroys the universal conductance fluctuations. The crossover behavior of the fluctuation amplitude from the usual quasi-1D situation to that of the mixed regime is clearly revealed, and the role of various length scales are identified. My analytical predictions were confirmed by a direct numerical simulation by evaluating the Landauer formula. In another direction, I have made several studies of conductance or resistance oscillations and fluctuations in systems with artificial impurities in the ballistic regime. My calculation gave explanations of all the experimental results concerning the classical focusing peaks of the resistance versus magnetic field, the weak localization peak in a Sinai billiard system, the formation of a chaotic billiard, and predicted certain transport features which were indeed found experimentally. I have further extended the calculation to study the Hall resistance in a four-terminal quantum dot in which there is an antidot array. From my numerical data I analyzed the classical paths of electron motion and its quantum oscillations. The results compare well with recent experimental studies on similar systems. Since these billiard systems could provide quantum chaotic dynamics, I have made a detailed study of the consequence of such dynamics. In particular I have investigated the resonant transmission of electrons in these chaotic systems, and found that the level

  5. A Study to Determine the Best Staffing Method for Identifying the Ancillary Staffing Requirements for Selected Outpatient Clinics at the Blanchfield Army Community Hospital

    DTIC Science & Technology

    1989-07-14

    i Criteria ........ . . . . . . ... 12 m Assumptions . .. .... ...... 13 Z Limitations ........ I ....... .. 14 mz Review of the Literature...important, many of these tasks were menial in nature and less labor-intensive and can be complete; in less time than when the physician is physically in... review of existing models that identify methods a -4 for maximizing the proper utilization of ancillary personnel and for O m delineating staffing

  6. 45 CFR 1336.65 - Staffing and organization of the Revolving Loan Fund: Responsibilities of the Loan Administrator.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... organization table, including: (a) The structure and composition of the Board of Directors of the RLF; (b) The... 45 Public Welfare 4 2011-10-01 2011-10-01 false Staffing and organization of the Revolving Loan... Hawaiian Revolving Loan Fund Demonstration Project § 1336.65 Staffing and organization of the Revolving...

  7. 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

    ..., Inc., and Human Capital Staffing Clinton Township, MI, et al.; Amended Certification Regarding..., LLC. New information shows that workers leased from Human Capital Staffing were employed on-site at..., Modern Professional Services, LLC, TAC Transportation, Time Services, Inc., and Human Capital...

  8. Staffing Patterns in Public School Systems: Current Status and Trends, Update 2003. A Reference Tool for School Administrators. Research Snapshot.

    ERIC Educational Resources Information Center

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

    This research brief examines staffing patterns within U.S. public school systems. Specifically, it answers the following sets of questions: (1) Why is information about staffing ratios important? (2) How many people currently work in public schools? What proportion of these are teachers, administrators, and support staff? (3) What are the current…

  9. 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…

  10. Staffing Patterns in Public School Systems: Current Status and Trends, Update 2003. A Reference Tool for School Administrators. Research Snapshot.

    ERIC Educational Resources Information Center

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

    This research brief examines staffing patterns within U.S. public school systems. Specifically, it answers the following sets of questions: (1) Why is information about staffing ratios important? (2) How many people currently work in public schools? What proportion of these are teachers, administrators, and support staff? (3) What are the current…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  12. "The Role of the Teaching Assistant in the Unitized, Differentiated Staffing, Elementary School." DSP Progress Report No. 4: Paraprofessionals.

    ERIC Educational Resources Information Center

    Arends, Richard I.; Essig, Don M.

    This report is the fourth in a series describing the background, theory, and progress of the Differentiated Staffing Project in the Eugene, Oregon, School District. This report discusses the effects of the addition of paid paraprofessionals, or Teaching Assistants (TAs), to the unitized, differentiated staffing schools in Eugene. Specifically, it…

  13. 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

    ... and Office Team working on-site at the Itasca, Illinois location of Venta-Airwasher, LLC. The amended..., LLC, Including On-Site Leased Workers From Metro Staffing, Snelling and Office Team Itasca, IL... leased workers from Metro Staffing, Snelling and Office Team were employed on-site at the...

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  15. 77 FR 40638 - Syniverse Technologies, Inc., Including On-Site Leased Workers From Insight Global Stone Staffing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-10

    ... Insight Global Stone Staffing, and Randstad Formerly Known as Sapphire Technologies, Watertown, MA... workers from Insight Global, Stone Staffing, Randstad formerly known as Sapphire Technologies, Watertown..., formerly known as Sapphire Technologies, were employed on-site at the Watertown, Massachusetts location...

  16. 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

    ... FirstStaff, Trac Staffing, and Worksource, Inc., Fort Smith, Arkansas; Amended Certification Regarding... Industries, LLC including on-site leased workers from FirstStaff, Trac Staffing, Worksource, Inc., Fort Smith... at the Fort Smith, Arkansas location of River Bend Industries, LLC. The Department has determined...

  17. 25 CFR 36.81 - May a homeliving program use support staff or teachers to meet behavioral health staffing...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false May a homeliving program use support staff or teachers to... program use support staff or teachers to meet behavioral health staffing requirements? No, a homeliving program must not use support staff or teachers to meet behavioral health staffing requirements. The...

  18. 25 CFR 36.81 - May a homeliving program use support staff or teachers to meet behavioral health staffing...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false May a homeliving program use support staff or teachers to... program use support staff or teachers to meet behavioral health staffing requirements? No, a homeliving program must not use support staff or teachers to meet behavioral health staffing requirements. The...

  19. 25 CFR 36.81 - May a homeliving program use support staff or teachers to meet behavioral health staffing...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true May a homeliving program use support staff or teachers to... program use support staff or teachers to meet behavioral health staffing requirements? No, a homeliving program must not use support staff or teachers to meet behavioral health staffing requirements. The...

  20. 25 CFR 36.78 - What are the staffing requirements for homeliving programs offering less than 5 nights service?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... programs offering less than 5 nights service? 36.78 Section 36.78 Indians BUREAU OF INDIAN AFFAIRS... staffing requirements for homeliving programs offering less than 5 nights service? For homeliving programs providing less than 5 nights service, the staffing levels from 36.77 apply. To fill this requirement,...

  1. 76 FR 13665 - Cambridge Tool & Die, Including On-Site Leased Workers From Action Total Staffing, Cambridge, OH...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-14

    ... certification to include workers leased from Action Total Staffing working on-site at the Cambridge, Ohio... Employment and Training Administration Cambridge Tool & Die, Including On-Site Leased Workers From Action Total Staffing, Cambridge, OH; Amended Certification Regarding Eligibility To Apply for...

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

    ERIC Educational Resources Information Center

    Herman, Jennifer H.

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Herman, Jennifer H.

    2013-01-01

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

  4. Half Empty or Half Full? Staffing Trends in Academic Libraries at U.S. Research Universities, 2000-2008

    ERIC Educational Resources Information Center

    Stewart, Christopher

    2010-01-01

    This study is a quantitative analysis of FTE staffing levels at academic libraries at 176 U.S. research universities between 2000 and 2008. Results showed that overall staffing levels at these libraries declined but that the average number of professional librarian FTE positions modestly increased. Other professional staff positions increased at a…

  5. Reversible fluctuation rectifier

    NASA Astrophysics Data System (ADS)

    Sokolov, I. M.

    1999-10-01

    The analysis of a Feynman's ratchet system [J. M. R. Parrondo and P. Español, Am. J. Phys. 64, 1125 (1996)] and of its electrical counterpart, a diode engine [I. M. Sokolov, Europhys. Lett. 44, 278 (1998)] has shown that ``fluctuation rectifiers'' consisting of a nonlinear element (ratchet, diode) and a linear element (vane, resistor) kept at different temperatures always show efficiency smaller than the Carnot value, thus indicating the irreversible mode of operation. We show that this irreversibility is not intrinsic for a system in simultaneous contact with two heat baths at different temperatures and that a fluctuation rectifier can work reversibly. This is illustrated by a model with two diodes switched in opposite directions, where the Carnot efficiency is achieved when backward resistivity of the diodes tends to infinity.

  6. Multiscale Fluctuation Analysis Revisited

    NASA Astrophysics Data System (ADS)

    Struzik, Zbigniew R.; Kiyono, Ken; Yamamoto, Yoshiharu

    2007-07-01

    Ubiquitous non-Gaussianity of the probability density of (time-series) fluctuations in many real world phenomena has been known and modelled extensively in recent years. Similarly, the analysis of (multi)scaling properties of (fluctuations in) complex systems has become a standard way of addressing unknown complexity. Yet the combined analysis and modelling of multiscale behaviour of probability density — multiscale PDF analysis — has only recently been proposed for the analysis of time series arising in complex systems, such as the cardiac neuro-regulatory system, financial markets or hydrodynamic turbulence. This relatively new technique has helped significantly to expand the previously obtained insights into the phenomena addressed. In particular, it has helped to identify a novel class of scale invariant behaviour of the multiscale PDF in healthy heart rate regulation during daily activity and in a market system undergoing crash dynamics. This kind of invariance reflects invariance of the system under renormalisation and resembles behaviour at criticality of a system undergoing continuous phase transition — indeed in both phenomena, such phase transition behaviour has been revealed. While the precise mechanism underlying invariance of the PDF under system renormalisation of both systems discussed is not to date understood, there is an intimate link between the non-Gaussian PDF characteristics and the persistent invariant correlation structure emerging between fluctuations across scale and time.

  7. Fluctuations of fish populations and the magnifying effects of fishing.

    PubMed

    Shelton, Andrew O; Mangel, Marc

    2011-04-26

    A central and classic question in ecology is what causes populations to fluctuate in abundance. Understanding the interaction between natural drivers of fluctuating populations and human exploitation is an issue of paramount importance for conservation and natural resource management. Three main hypotheses have been proposed to explain fluctuations: (i) species interactions, such as predator-prey interactions, cause fluctuations, (ii) strongly nonlinear single-species dynamics cause fluctuations, and (iii) environmental variation cause fluctuations. We combine a general fisheries model with data from a global sample of fish species to assess how two of these hypothesis, nonlinear single-species dynamics and environmental variation, interact with human exploitation to affect the variability of fish populations. In contrast with recent analyses that suggest fishing drives increased fluctuations by changing intrinsic nonlinear dynamics, we show that single-species nonlinear dynamics alone, both in the presence and absence of fisheries, are unlikely to drive deterministic fluctuations in fish; nearly all fish populations fall into regions of stable dynamics. However, adding environmental variation dramatically alters the consequences of exploitation on the temporal variability of populations. In a variable environment, (i) the addition of mortality from fishing leads to increased temporal variability for all species examined, (ii) variability in recruitment rates of juveniles contributes substantially more to fluctuations than variation in adult mortality, and (iii) the correlation structure of juvenile and adult vital rates plays an important and underappreciated role in determining population fluctuations. Our results are robust to alternative model formulations and to a range of environmental autocorrelation.

  8. Chiral fluctuations in achiral systems

    NASA Astrophysics Data System (ADS)

    Harris, Robert A.

    2001-12-01

    "Chiral fluctuations" are defined, and their relation to "dynamic chirality" is discussed. Simple experiments to measure chiral fluctuations are proposed. The unique aspects of these measurements for systems such as atomic clusters and gases are outlined.

  9. Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study.

    PubMed

    Ball, Jane E; Bruyneel, Luk; Aiken, Linda H; Sermeus, Walter; Sloane, Douglas M; Rafferty, Anne Marie; Lindqvist, Rikard; Tishelman, Carol; Griffiths, Peter

    2017-08-24

    Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses' staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse's workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1.159 95% CI 1.039-1.294) increase in the odds of a patient dying within 30days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an 'early warning' indicator of higher risk for poor patient outcomes. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All

  10. The Fluctuation Theorem

    NASA Astrophysics Data System (ADS)

    Evans, Denis J.; Searles, Debra J.

    2002-11-01

    The question of how reversible microscopic equations of motion can lead to irreversible macroscopic behaviour has been one of the central issues in statistical mechanics for more than a century. The basic issues were known to Gibbs. Boltzmann conducted a very public debate with Loschmidt and others without a satisfactory resolution. In recent decades there has been no real change in the situation. In 1993 we discovered a relation, subsequently known as the Fluctuation Theorem (FT), which gives an analytical expression for the probability of observing Second Law violating dynamical fluctuations in thermostatted dissipative non-equilibrium systems. The relation was derived heuristically and applied to the special case of dissipative non-equilibrium systems subject to constant energy 'thermostatting'. These restrictions meant that the full importance of the Theorem was not immediately apparent. Within a few years, derivations of the Theorem were improved but it has only been in the last few of years that the generality of the Theorem has been appreciated. We now know that the Second Law of Thermodynamics can be derived assuming ergodicity at equilibrium, and causality. We take the assumption of causality to be axiomatic. It is causality which ultimately is responsible for breaking time reversal symmetry and which leads to the possibility of irreversible macroscopic behaviour. The Fluctuation Theorem does much more than merely prove that in large systems observed for long periods of time, the Second Law is overwhelmingly likely to be valid. The Fluctuation Theorem quantifies the probability of observing Second Law violations in small systems observed for a short time. Unlike the Boltzmann equation, the FT is completely consistent with Loschmidt's observation that for time reversible dynamics, every dynamical phase space trajectory and its conjugate time reversed 'anti-trajectory', are both solutions of the underlying equations of motion. Indeed the standard proofs of

  11. Managing Faculty Reductions

    ERIC Educational Resources Information Center

    Alm, Kent F.; And Others

    1977-01-01

    A process for the management of reductions in the number of faculty positions available to a university is described. It considers staffing by projections, the evolution of personnel planning, and the balance of reductions in faculty and administration, along with coping strategies and advice growing out of five years of enrollment decline…

  12. Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11.

    PubMed

    Li, Yue; Harrington, Charlene; Mukamel, Dana B; Cen, Xi; Cai, Xueya; Temkin-Greener, Helena

    2015-12-01

    Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001-11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities. Project HOPE—The People-to-People Health Foundation, Inc.

  13. Further Examination of the Influence of Caregiver Staffing Levels on Nursing Home Quality

    ERIC Educational Resources Information Center

    Castle, Nicholas G.; Engberg, John

    2008-01-01

    Purpose: Weak empirical evidence exists showing that nursing home staffing levels influence quality of care. We propose that weak findings have resulted in many prior analyses because research models have underspecified the labor composition needed to influence care processes that, in turn, influence quality of care. In this analysis, we specified…

  14. 7 CFR 800.148 - Maintenance and retention of records on organization, staffing, and budget.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... approved scale testing organizations shall maintain complete records of their organization. These records... records shall be maintained for 5 years. (b) Staffing. Agencies, contractors, and approved scale testing... scale testing organizations shall maintain complete records of their budget. These records consist of...

  15. The Schools and Staffing Survey. Recommendations for the Future. Conference Proceedings.

    ERIC Educational Resources Information Center

    Mullens, John E.; Kasprzyk, Daniel

    The Schools and Staffing Survey (SASS) was designed by the National Center for Education Statistics (NCES) to provide recurrent information about public and private elementary and secondary schools, teachers, and administrators. The NCES commissioned these papers to examine the SASS and to make recommendations about its future. The following…

  16. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  17. Social Problem Solving in Staffed Community Homes among Individuals with Intellectual Disabilities and Their Staff

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Miller, Arlene Michaels; Fogg, Louis

    2014-01-01

    Individuals with intellectual disabilities (ID) increasingly live with other individuals with ID in small community homes staffed by paraprofessionals where aggressive/challenging (problem) behaviors occur more frequently then among individuals with ID living with their families. Evidence suggests that individuals with ID are more susceptible to…

  18. Registered Nurse Staffing Mix and Quality of Care in Nursing Homes: A Longitudinal Analysis

    ERIC Educational Resources Information Center

    Kim, Hongsoo; Harrington, Charlene; Greene, William H.

    2009-01-01

    Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…

  19. Planning Faculty Staffing for the 1980's: A Case Study. AIR Forum 1981 Paper.

    ERIC Educational Resources Information Center

    Geiger, Joseph; Manning, Charles W.

    The development and use of the faculty staffing forumla for Colorado, prepared by the Association of Public College and University Presidents (APCUP), is examined, and a recent major attempt to update or modify the formula is described, along with the outcome. Based on the work of representatives from many campuses, a large scale computer…

  20. Optimal Choice of Periodicities for the Schools and Staffing Survey: Modeling and Analysis.

    ERIC Educational Resources Information Center

    Smith, Wray; Ghosh, Dhiren; Chang, Michael

    This technical report provides an updated assessment of the problem of optimizing the periodicity of the Schools and Staffing Survey (SASS). Making use of data from three rounds of SASS data collection (for school years 1987-88, 1990-91, and 1993-94), the report extends and updates the preliminary findings and interim assessments that were…