Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China.

AIM: To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN: A nationwide cross-sectional online survey. METHODS: A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS: The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

'I have enough pressure as it is, without the worry of doing something wrong because of ignorance': The impact of Covid-19 on people who employ social care personal assistants

People with care and support needs were often badly affected by Covid-19, although the impact on people employing Personal Assistants (PAs) has not been addressed. We aimed to explore the experiences of people employing PAs during the pandemic to inform care systems and social work practice. Remote qualitative interviews were conducted with seventy PA employers across England in 2021–2022. Data were analysed thematically to explore salient themes. The Covid-19 pandemic elucidated role tensions of PA employers: Navigating care arrangements during a time of unprecedented uncertainty reinforced participants' role as an employer, but exposed some aspects of employment responsibilities and legal obligations that participants felt ill-equipped to manage. Reports of contact with or by social workers were few and not perceived as helpful. The often-informal nature of PA arrangements and its blurred relational boundaries affected participants' expectations of their PAs. PA employers would welcome support from social workers in their employment role and flexibility with care plans, albeit with greater autonomy over their Direct Payment (DP) budget to enhance the potential of this arrangement. In the context of declining DP uptake in England, our study offers some potential explanations for this, with suggestions for systemic change and social work practice.

Community diagnostic centres: what, where and why?

The British Journal of Healthcare Management's editor discusses the potential benefits of community diagnostic centres for patients and the wider NHS, along with key considerations to drive this model forward.

Changing English Local Authority Duties by the Adoption of Easements in the COVID-19 Pandemic, Findings from an Interview-Based Study

This article reports findings from a study on the effect of the adjustments or 'easements' that were made to the 2014 Care Act when measures to manage the impact of COVID-19 were introduced in England in 2020. Only eight local authorities (LAs) implemented the changes permitted. The experiences of five are explored in this article. Data were collected in 2021 through interviews with Directors of Adult Social Services and other senior managers in these LAs and analysed using a thematic approach. Participants referred to the challenges under which they were working pre-pandemic, including resource pressures and problems recruiting and retaining staff. Despite the conditions attached to adopting easements these LAs had done so because of the uncertainties they were facing. All ceased to use them within a short time because they could manage without them. They had been shocked by the concerted opposition to easements and the time necessitated in responding to this. They contrasted their experiences with the apparent ease with which NHS colleagues had been able to change their practices. The experiences of these LAs may contribute to planning for the continuity of social care in any future emergency.

The Use of Interpreters in Health Centers: A Mixed-Methods Analysis

Health centers serve millions of patients with limited English proficiency (LEP) through highly variable language services programs that reflect patient language preferences, the availability of bilingual staff, and very limited sources of third-party funding for interpreters. We conducted a mixed-methods study to understand interpreter services delivery in federally qualified health centers during 2009–2019. Using the Uniform Data System database, we conducted a quantitative analysis to determine characteristics of centers with and without interpreters, defined as staff whose time is devoted to translation and/or interpreter services. We also analyzed Medicaid-relevant policies' association with health centers' interpreter use. The qualitative component used a sample of 28 health centers to identify interpreter services models. We found that the use of interpreters, as measured by the ratio of interpreter full-time equivalents per patients with LEP, decreased between 2009 and 2019. We did not find statistically significant relationships between interpreter staffing and number of patients with LEP served, or in our examination of Medicaid-relevant policies. Our qualitative analysis uncovered homegrown models with varying program characteristics. Key themes included the critical role of bilingual staff, inconsistent interpreter training, and the reasonably smooth transition to virtual interpretation during COVID-19.

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises

Purpose: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. Methods: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. Results: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

Timing of submissions to The Journal of Paediatrics and Child Health: Associations with the COVID-19 pandemic and editorial decisions.

AIM: To determine if the timing of manuscript submissions to The Journal of Paediatrics and Child Health (JPCH) changed following the onset of the COVID-19 pandemic and to determine if the timing of manuscript submissions influenced editorial decisions. METHODS: A retrospective observational study of submissions to JPCH from 1 January 2015 to 1 August 2022 was performed. Regression models were used to explore the change over time. Editorial decisions were examined using a multinomial regression model with the three-category ordinal outcome of reject, revise and accept. All statistical models were fitted using a Bayesian approach and show 95% credible intervals (CI). RESULTS: The analyses included 11 499 manuscript submissions between 2015 and 2022. The mean number of manuscript submissions increased by 17 papers per month (CI 15-19), with a larger 4-month long increase after the COVID-19 pandemic was declared of 86 submissions per month (CI 67-103). There was no clear effect of the pandemic on weekend submissions, mean difference in probability 0.003 (CI -0.021 to 0.026). Throughout the study period, the peak submission time was later in the day and was shifted +37 min later post-March 2020 (CI +22 to +52 min). Throughout the study period, submissions out-of-hours and on weekends were less likely to get an editorial decision of 'accept' or 'revise': odds ratio weekend versus weekday 0.87 (CI 0.78-0.97). CONCLUSION: The COVID-19 pandemic had a limited effect on the timing of manuscript submissions to JPCH. However, the timing of manuscript submission impacted the likelihood of a more positive editorial decision. While the time of manuscript submission is only one part of the research process, it is postulated that it may be associated with research quality.

Managing the Nursing Shortage During the Covid-19 Pandemic: A Qualitative Study.

Background: Nursing care contributes to the safety and the quality of care of patients. During the COVID-19 pandemic, nurses became frontline care providers. Materials and Methods: A qualitative study was conducted using an online focus group discussion of eight nurse committee members from six hospitals. After the data were collected, the study continued with inductive thematic analysis. The data were organized and extracted to identify meaningful statements and formulate meanings. Inductive thematic analysis was used, resulting in three themes and six subthemes. Results: The themes related to managing the nursing workforce, schedules, rosters, shifts, goals of re-design staffing, and the nurse-patient ratio. Conclusions: The management of the nursing staffing was modified to protect nurses during the COVID-19 pandemic. The nurse manager redesigned workforce planning to ensure a safe environment for nurses.

The NHS in crisis: what does this mean for neurology?

As 2022 draws to a close, the NHS has never been in a more fragile condition. As a result of the COVID-19 pandemic and, more recently, inflation and the cost-of-living crisis, the NHS is under some of the most significant pressures in its history. But how do these pressures impact on neurology services? Sue Thomas explores the main issues causing the NHS crisis and delves into how neurology services need to respond.

Home- and community-level predictors of social connection in nursing home residents: A scoping review.

Background and Aims: Social connection is associated with better physical and mental health and is an important aspect of the quality of care for nursing home residents. The primary objective of this scoping review was to answer the question: what nursing home and community characteristics have been tested as predictors of social connection in nursing home residents? The secondary objective was to describe the measures of social connection used in these studies. Methods: We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified associations between nursing home and/or community characteristics and resident social connection. Searches were limited to English-language articles published from database inception to search date (July 2019) and update (January 2021). Results: We found 45 studies that examined small-scale home-like settings (17 studies), facility characteristics (14 studies), staffing characteristics (11 studies), care philosophy (nine studies), and community characteristics (five studies). Eight studies assessed multiple home or community-level exposures. The most frequent measures of social connection were study-specific assessments of social engagement (11 studies), the Index of Social Engagement (eight studies) and Qualidem social relations (six studies), and/or social isolation (five studies) subscales. Ten studies assessed multiple social connection outcomes. Conclusion: Research has assessed small-scale home-like settings, facility characteristics, staffing characteristics, care philosophy, and community characteristics as predictors of social connection in nursing home residents. In these studies, there was no broad consensus on best approach(es) to the measurement of social connection. Further research is needed to build an evidence-base on how modifiable built environment, staffing and care philosophy characteristics-and the interactions between these factors-impact residents' social connection.

Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic...Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Convention, 25-29 June, 2022, Aurora, Colorado

The article offers information about the missed critical nursing care processes on labor and delivery units during the Covid-19 pandemic. It mentions that study examined the rates of three critical nursing care processes on labor and delivery units and assessed the relationship with reports of reduced nursing time at the bedside and frequency of unit staffing adequacy during the Covid-19 pandemic in the U.S.

État des connaissances - Organisation des soins et services médicaux en milieu d’hébergement et de soins de longue durée

Objectives:The Ministère de la Santé et des Services sociaux (MSSS) would like the medical management arrangements and multidisciplinary care models used in long-term care facilities in other countries to be explored. The objectives of this report are, therefore, to document, in Canada and other OECD (Organisation for Economic Co-operation and Development) member countries, i) the offer of medical care and services and how medical care is provided, ii) the composition of medical care and services teams and the roles and responsibilities of their members (physicians, nurses, specialized nurse practitioners and pharmacists), and iii) physician involvement in the facilities’ management. Conclusions:RESULTS: The availability of physicians in long-term care facilities varies around the world. Some countries and provinces (e.g., the U.S., Ontario and British Columbia) have standards or legislation governing how care is provided. The implementation of standards appears to create value by clarifying medical expectations and providing more medical care and services in a timely fashion. Physician involvement outside of normal work hours varies as well (i.e., daytime from Monday to Friday). To meet the needs of residents outside these hours, access to telephone support and telemedicine between the facility’s care team and a physician seem to be methods used in some provinces and countries (e.g., Ontario, France, Norway and Australia). As for the number of medical visits per 2 year per resident, it seems to vary between 7 and 10, according to information from British Columbia, Manitoba and the United States. In the United States in 2015, there was the equivalent of 1.37 full-time equivalent (FTE) physicians per 1,000 occupied nursing home beds. This is far from the ratio recommended by U.S. experts of one FTE physician per 10 skilled nursing facility beds (facilities with, among other things, temporary physical rehabilitation beds) and 100 nursing facility beds. In Ontario, it is recommended that 4 hours per week be spent on medical practice in long-term care facilities for every 25 to 30 residents. Different practices and types of collaboration are used among different professionals working in long-term care facilities in order to optimize the provision of care for the residents. The three main types of skill mix described in the literature are (1) delegation (the physician assigns a task to another health care professional but remains responsible for it), (2) substitution (expanding the responsibilities of a health care professional, who may then provide some of the same services as the physician and becomes responsible and autonomous in performing these tasks), and (3) supplementation (increasing the scope of a health care professional’s work by allowing them to provide additional services that complement or extend those provided by the physician). Although a combination of all three types is reported in practice, physician substitution with different professionals, such as specialized nurse practitioners (SNPs) and physician assistants, is the one most documented in the publications reviewed. CONCLUSION: The results presented in this state-of-knowledge report provide relevant avenues for reflection on the organization of medical care and services in long-term care facilities. The topics discussed include the different staffing models in place across the OECD countries, the variability in the level of physician involvement in the management of these facilities (and the form of this involvement), and the several forms of skill mix. These results provide insight on the organization of care and services and the sharing of responsibilities among the various members of the care team. Given the aging of the population, the increasing complexity of the residents’ profile, and the difficulties recruiting qualified workers, efforts will certainly have to be made to adjust the way things are done and to continue to offer quality care and services. This reflective work is all the more necessary given the significant impact the COVID-19 pandemic has had on the health and social services system. Lastly, there are several tensions in the mission of long-term care facilities, which is to offer quality care and services in a quality living environment. The combination of these two goals in the reflection on the organization of medical care and services is essential for ensuring residents’ well-being. Methods:The Institut national d'excellence en santé et en services sociaux (INESSS) has prepared a state-of-knowledge report based on the scientific literature and websites of organizations, learned societies and government bodies. A total of 58 primary studies, 9 reviews, 9 expert opinions published in a scientific journal, reports from 7 governments and 23 organizations were examined.

A new model helps hospitals stay ahead of the staffing curve

The article provides information on an internal travel pool for nurses implemented by Novant Health in 2013. Topics discussed include the opportunity provided by the model to staff nurses, forecast made by the U.S. Bureau of Labor Statistics on the number of nurses that would leave their jobs even before the pandemic, and changes that have been implemented, underway or are under consideration as the organization seeks to further establish its internal pool as a viable option.

How to future-proof your travel nurse and clinician staffing

The article discusses a lesson from Trinity Health for other health systems on how to address clinician staffing challenges that were exacerbated by the pandemic. Topics include guiding principles for creating a modern internal travel nurse program, a response to a long-standing need, and the savings from Trinity Health's in-house travel staffing approach in fiscal year 2021.