The Changing Landscape of Substitute School Nursing A School Nurse Administrator Roundtable.

School nurse administrators increasingly express concerns over the availability of substitute school nurses with return to in-person learning after the height of the COVID-19 pandemic. While healthcare staffing concerns and shortages are not unique to the school setting, the increasing health acuity of the student population, delegation principles, and staffing models complicate the issue. Traditional methods of covering absences may no longer suffice. In this article, five school nurse administrators share strategies, comparing pre-pandemic to current day facilitation of providing coverage for the absences of their healthcare staff.

Assessing the impacts of nurse staffing and work schedules on nurse turnover: A systematic review.

AIM: This study aimed to investigate and synthesize the impacts of nurse staffing and work schedules on nurse turnover in acute hospitals. BACKGROUND: The retention of nurses during the COVID-19 pandemic was critical due to the increased demand for nurses. Among the multifaceted factors contributing to nurse turnover, it is worth examining nurse staffing and work schedules while considering policy intervention. METHODS: The findings of this systematic literature review were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using eight databases, including CINAHL and PubMed, research articles published from January 2000 until June 2021 were reviewed. The inclusion criteria were original peer-reviewed research, nonexperimental studies published in English or Korean languages, and studies examining the impacts of nurse staffing and work schedules on nurses' actual turnover. RESULTS: Fourteen articles were reviewed. Among them, 12 studies investigated the relationship between nurse staffing and turnover, and four examined the impact of work schedules on nurse turnover. Nurse staffing levels are strongly related to nurse turnover in the expected direction. However, few studies have found that work schedules are significantly related to nurse turnover. CONCLUSION: Inadequate and unsafe nurse staffing leads to increased nurse turnover rates. More studies are needed to investigate the impacts of work schedules on nurse turnover. IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Several states in the United States have adopted the nurse staffing policy during the COVID-19 pandemic. More hospitals and the government should adopt and implement policies to regulate nurse staffing, reduce nurse turnover, and increase retention. Policy intervention in nurse work schedules should also be considered to prevent nurse turnover.

Predicting Oxygen Utilization & Nurse Staffing Needs For COVID-19

Supplemental oxygen is an essential part of in-hospital care for most patients hospitalized with SARS-CoV-2 pneumonia. This study seeks to identify hospitalized patients who will require advanced oxygen support (high flow oxygen, CPAP, BiPAP, or mechanical ventilation) within 96 hours of admission using a machine learning model. This information can be useful for hospitals to plan for nurse staffing, as patients will consume more resources and will need more staff assistance.Data from 302 SARS-CoV-2 patients was used to create a classifier to predict whether or not patients would require advanced oxygen support within 96 hours of admission. Of the 302 cases, 211 were randomly selected to train the model, and 91 were randomly selected for testing. Through a labeled dataset, we performed supervised learning by using a random forest ensemble model which included demographic, clinical comorbidities, vitals, and laboratory values. We used 5-fold cross-validation to evaluate our trained model and employed a majority vote decision across the five trained models in order to produce the final prediction for a given patient. Through the models, we yielded results through sensitivity, specificity, positive predictive value, negative predictive value, and F1 score with the 91 cases of training data.An additional 24 cases were used to test the validity of the ensemble consensus model. Approximately 40% of all patients progressed to require advanced oxygen support 96 hours after the initial presentation.Although the insight gained from the model may not definitively predict the course of an individual patient, this model may help hospital administrators plan for staffing needs with a 48-hour lead time. Patients on high oxygen support require high acuity beds, which have increased nurse-to-patient ratios. Additional samples may increase its statistical significance. Nevertheless, this model demonstrates the potential and viability of using data science to help manage hospital resources. © 2022 IEEE.

Exploring the Evidence: Focusing on the Fundamentals Exploring the Evidence: Considerations for the Dialysis Practice Setting Approach to Staffing

Nursing remains one of the most in-demand jobs in the American workforce. The impact of the COVID-19 pandem-ic has created strain on nursing resources throughout the health care industry and drawn attention to longstanding workforce issues. Inadequate staffing is often a multidi-mensional problem that warrants a comprehensive assessment of elements that may contribute to recruit-ment and retention issues. In the dialysis practice setting, nursing shortages remain an ongoing issue due to an aging workforce and ongoing issues for recruiting nurses both new and skilled into the field of nephrology. This article explores the evidence on approaches to staffing in the dial-ysis practice setting by defining core elements to consider when designing a staffing model. These elements include federal/state regulations, patient acuity, staff ratios, work-force perceptions, patient outcomes, and dialysis modali-ties offered.

Exploring the Evidence: Considerations for the Dialysis Practice Setting Approach to Staffing.

Nursing remains one of the most in-demand jobs in the American workforce. The impact of the COVID-19 pandemic has created strain on nursing resources throughout the health care industry and drawn attention to longstanding workforce issues. Inadequate staffing is often a multidimensional problem that warrants a comprehensive assessment of elements that may contribute to recruitment and retention issues. In the dialysis practice setting, nursing shortages remain an ongoing issue due to an aging workforce and ongoing issues for recruiting nurses both new and skilled into the field of nephrology. This article explores the evidence on approaches to staffing in the dialysis practice setting by defining core elements to consider when designing a staffing model. These elements include federal/state regulations, patient acuity, staff ratios, workforce perceptions, patient outcomes, and dialysis modalities offered.

Conditions of Nursing Practice in Hospitals and Nursing Homes Before COVID-19: Implications for Policy Action.

Background: The COVID-19 pandemic has stimulated interest in potential policy solutions to improve working conditions in hospitals and nursing homes. Policy action in the pandemic recovery period must be informed by pre-pandemic conditions. Purpose: To describe registered nurses' (RNs') working conditions, job outcomes, and measures of patient safety and care quality in hospitals and nursing homes just before the pandemic. Methods: Cross-sectional study using descriptive statistics to analyze survey data from RNs in New York and Illinois collected December 2019 through February 2020. Results: A total of 33,462 RNs were included in the final analysis. Before the pandemic, more than 40% of RNs reported high burnout, one in four were dissatisfied with their job, and one in five planned to leave their employer within 1 year. Among nursing home RNs, one in three planned to leave their employer. RNs reported poor working conditions characterized by not having enough staff (56%), administrators who did not listen/respond to RNs' concerns (42%), frequently missed nursing care (ranging from 8% to 34% depending on the nursing task in question), work that was interrupted or delayed by insufficient staff (88%), and performing non-nursing tasks (82%). Most RNs (68%) rated care quality at their workplace as less than excellent, and 41% gave their hospital an unfavorable patient safety rating. Conclusion: Hospitals and nursing homes were understaffed before the COVID-19 pandemic, and many RNs were dissatisfied with their employers' contribution to the widespread observed shortage of nursing care during the pandemic. Policy interventions to address understaffing include the implementation of safe nurse staffing standards and passage of the Nurse Licensure Compact to permit RNs to move expeditiously to locales with the greatest needs.

Leading During a Pandemic: A School Nurse Administrator Roundtable.

The ongoing COVID-19 pandemic has been taxing to healthcare workers, no less for those serving on the front lines in schools. From initial school closures and online learning to gradual reopening with hybrid learning models, to full in-person learning, school nurse administrators provided guidance in collaboration with public health officials, based on evolving information. Infection control was at the forefront, while government and scientists partnered to quickly develop effective vaccines. Technology provided new virtual platforms for learning, conducting meetings, and socialization, while also being widely used to deliver information, misinformation, and disinformation. Challenges have been numerous, but school nurse administrators and school nurses in general, with a commitment to the health and safety of their populations, continue to adapt to the ever-changing demands. The journal's Editorial Advisory Board interviewed five school nurse administrators, representative of diverse geographic locations, school population size, and employer models, to capture their reflections on school health leadership during the COVID-19 pandemic. History is deserving of their stories.

Staffing Levels and COVID-19 Infections and Deaths in Korean Nursing Homes.

The novel coronavirus disease 2019 (COVID-19) spread rapidly worldwide. Nursing home (NH) residents are the most vulnerable high-risk population to infection. Professional registered nurses' (RNs') infection control is irreplaceable. We used a secondary data analysis method using the government's senior citizen welfare department large data set about all NHs (N = 3,389) across Korea between January 20 and October 20, 2020. Bed size positively associated with the mortality rate (No. of COVID-19 resident deaths / No. of total residents) (p = .048). When the proportion of RNs to total nursing staff was higher, the infection rate was 0.626% lower (p = .049), the mortality rate was 0.088% lower (p = .076), the proportion of confirmed COVID-19 cases per resident out of the total number of NHs was 44.472% lower (p = .041), and the proportion of confirmed COVID-19 deaths per resident out of the total number of NHs was 6.456% lower (p = .055). This study highlighted nurse staffing criteria and suggests that increasing RNs in NHs will reduce infection and mortality rates during the COVID-19 pandemic. We strongly suggest NHs hire at least one RN per day to properly function, and a minimum of four RNs to provide a fully competent RN workforce in long-term care settings in Korean NHs.

Everyday Life and Social Contacts of Dementia and Non-Dementia Residents over 80 Years in Long-Term Inpatient Care: A Multi-Level Analysis on the Effect of Staffing.

The relationship between nurse staffing, physical outcomes of residents, as well as quality of care receives major attention. The impact of staffing levels on residents' ability to organize their everyday life and maintain social contacts, however, has not been analyzed to date. This study examines whether a relationship between the staff-to-resident ratio for registered nurses and nursing home residents with and without dementia aged over 80 exists. Secondary data collected in the project inQS (indikatorengestützte Qualitätsförderung) were used (n = 1782, mean age = 88.14). The analyzed cross-sectional data were collected in winter 2019 in facilities of the Diocesan Caritas Association in Germany. A sum score formed from variables measuring residents' abilities to independently organize their everyday life and maintain social contacts functioned as the dependent variable. A multi-level regression analysis was performed. The results revealed that the ability of residents without dementia was significantly associated with the staff-to-resident ratio of registered nurses. This was not true for residents with dementia. For the latter, however, whether the facility offers a segregated care unit turned out to be significant. Additional and longitudinal research is indispensable to explain the inequality between the two groups analyzed.

Factors associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic.

BACKGROUND: The coronavirus outbreak has brought unprecedented pressures to many health care systems worldwide, potentially compromising nursing care delivery and overall health care services. AIMS: This study identified factors that contributed to missed nursing care and nurse-assessed quality of care during the coronavirus pandemic. METHODS: This study employed a cross-sectional research design using an online survey. Survey respondents were 295 frontline nurses from the Central Region of the Philippines. RESULTS: Missed care occurred at a low level, with "adequate patient surveillance" as the most often missed nursing care activity. Hospital facility size, nurse staffing levels, and patient safety culture predicted missed nursing care. Personal protective equipment adequacy, nurse staffing levels, and patient safety culture were identified as predictors of quality of care. CONCLUSION: Frontline nurses tended to miss clinical aspects of nursing care during the pandemic. Modifying elements of the work environment, including nurse staffing levels, safety culture, and adequacy of protective equipment, may reduce care compromise and improve the quality of nursing care. IMPLICATIONS FOR NURSING MANAGEMENT: By addressing the identified predictors, nurse managers could effectively develop appropriate interventions to support the professional role of nurses and ensure the delivery of complete, safe, and quality nursing care during the pandemic.

Workforce management and patient outcomes in the intensive care unit during the COVID-19 pandemic and beyond: a discursive paper.

AIMS: To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic. BACKGROUND: In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses. DESIGN: Discursive paper. FINDINGS: Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures. CONCLUSION: COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive. RELEVANCE TO CLINICAL PRACTICE: Objective measures commonly fail to capture the complexity of the critical care nurses' role despite evidence to indicate that as workload increases so does risk of patient mortality, job stress and attrition. Critical care nurses must lead system change to develop and evaluate valid and reliable workforce measures.

Pro-judge study: Nurses' professional judgement in nurse staffing systems.

AIMS: Aim of this study is to better understand the role of nurses' professional judgment in nurse staffing systems. DESIGN: Qualitative comparative case study design of nurse staffing systems in England and Wales. METHODS: Data will be collected through a variety of sources: individual interviews, observations of relevant meetings and analysis of key documents. Ethical approval for the study was granted in August 2020 from The Healthcare Research Ethics Committee (SREC reference: REC741). Data generation will be informed by science and technology studies and practice theories. DISCUSSION: Ensuring adequate numbers of nurses are available to care for patients in response to shifting demand is an international policy priority. Emerging evidence on the use of formal workforce planning methodologies across the developed world highlights both the centrality of nurses' professional judgement in nurse staffing methodologies and the urgent need for theoretically informed research to better understand and conceptualise its contribution to decision-making. This study is designed to address this gap in understanding. It takes advantage of nurses' experiences of managing the service and staffing impacts of the Covid-19 pandemic and differences in strategic approaches to nurse staffing systems between England and Wales. IMPACT: The research will: make visible the knowledge and skills that underpin professional judgement in nurse staffing decisions and provide a conceptual language with which to articulate this; lay the foundations for evidence-based programmes of nurse education and continuing professional development; furnish the evidence to inform the development of nurse-led decision support tools to augment professional judgement; and generate wider insights into the effectiveness of nurse staffing systems in practice.

Changes in Nurse Staffing Grades of Korean Hospitals during COVID-19 Pandemic.

The global COVID-19 pandemic is creating challenges to manage staff ratios in clinical units. Nurse staffing level is an important indicator of the quality of care. This study aimed to identify any changes in the nurse staffing levels in the general wards of hospitals in Korea during the COVID-19 pandemic. The unit of analysis was the hospitals. This longitudinal study observed the quarterly change of the nurse staffing grades in 969 hospitals in 2020. The nurse staffing grades ranged from 1 to 7 according to the nurse-patient ratio measured by the number of patients (or beds) per nurse. The major dependent and independent variables were the change of nurse staffing grades and three quarterly observation points being compared with those during the 1st quarter (1Q) of 2020, respectively. A generalized linear model was used. Unexpectedly, the nurse staffing grades significantly improved (2Q: RR, 27.2%; 95% confidence interval (CI), 15.1-27.6; p < 0.001; 3Q: RR, 95% CI, 20.2%; 16.9-21.6; p < 0.001; 4Q: RR, 26.6%; 95% CI, 17.8-39.6; p < 0.001) quarterly, indicating that the nurse staffing levels increased. In the comparison of grades at 2Q, 3Q, and 4Q with those at 1Q, most figures improved in tertiary, general, and small hospitals (p < 0.05), except at 3Q and 4Q of general hospitals. In conclusion, the nurse staffing levels did not decrease, but nursing shortage might occur.

COVID-19: Korean nurses' experiences and ongoing tasks for the pandemic's second wave.

Nurses are the largest group of healthcare workers in the world, and during the COVID-19 pandemic, nurses have been recognized worldwide as frontline warriors working hard to stem suffering, infection rates and deaths. Korean nurses experienced the effects of the pandemic earlier than in most other countries, and the work of our nurses has been recognized as a successful model in responding COVID-19. In this paper, we share the experiences of Korean nurses, including their experiences of workload, acute shortages of staff and equipment and work overload, and suggest ongoing tasks that need to be addressed to combat the pandemic's second wave and other possible waves. Specifically, the nursing issues relating to COVID-19 are critically reviewed and recommendations for each issue are suggested in terms of nursing staffing, practice and policy, as well as health policy.

Nurse Staffing and Coronavirus Infections in California Nursing Homes.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.