Recruiting and employing foreign nurse graduates in a large public hospital system.

Recruiting foreign nurse graduates (FNGs) is one way hospitals--particularly those in the nation's inner cities--are responding to the periodic and cyclic shortages that characterize the labor market for registered nurses. Until now, little was known about the overall efficacy of this strategy. This article reports the findings of an 18-month study of the recruitment and employment of FNGs by the New York City Health and Hospitals Corporation. Although considerably more expensive to recruit than domestic nurses, FNGs have higher retention rates than U.S.-educated nurses and possess other characteristics that make them desirable recruits for hospitals experiencing a nursing shortage.

Nurses' job satisfaction: are there differences between foreign and U.S.-educated nurses?

This article reports the results of a job satisfaction survey administered to foreign-educated and U.S. nurses at six New York City public hospitals. Although a comparison of results for foreign-educated nurses on temporary visas (N = 322) and U.S. nurses (N = 535) revealed demographic, education and work differences, no differences in level of satisfaction were found between the two groups. Cultural and work status differences that may have affected these results are discussed.

Two approaches to measuring quality in medical case management programs.

In a study of the quality of care in a medical case management program, five physician experts, applying criteria to medical records, found the care provided appropriate in a majority of 40 cases (10 each of head injury, spinal cord injury, high-risk infants, and AIDS). Nurses interviewing parents of 30 high-risk infants found general satisfaction with case management.

Private sector initiatives in case management.

Case management for high-cost patients is offered by virtually all private insurers and many health management firms. Despite the proliferation of the service, little is known about the process of case management, how it varies among vendors, what its impact is on short- and long-run patient costs, and what its effects are on quality. In this article, the authors present the results of a survey of insurance-based programs that reveal some process variations that could lead to differences in program effectiveness and cost.

An innovative approach to geriatric acute care delivery: the Choate-Symmes experience.

Hospitals, like those described in this study, must develop alternative models of health care delivery that allow them to respond to many challenges while providing high-quality health care to geriatric patients. In this program, 10-bed geriatric units were established in two hospitals, and patients age 65 and older were selected at random for admission to the units. Following comprehensive assessment, self-reliance was fostered using individualized interventions. Discharge planning began at admission. A multidisciplinary approach with regular team conferences including families was also used. Results of this approach suggest that such intervention can reduce length of stay without affecting quality of care. This paper describes the delivery model in detail, focuses on issues related to the implementation of the intervention, and highlights the lessons learned by Choate-Symmes personnel through their demonstration of the model.

Acute care delivery for the geriatric patient: an innovative approach.

As the elderly population and expenditures for health care continue to grow rapidly in the United States, how to provide high-quality, cost-effective geriatric care is becoming a pressing question. To address this question, Choate-Symmes Health Services, Inc, established 10-bed Geriatric Special Care Units (GSCUs) in its two suburban Boston hospitals. Care on the GSCUs is delivered under a primary nursing model and involves comprehensive assessment, development of individual care plans emphasizing independence and activity, an interdisciplinary patient care team, and family participation in care planning. Patients were randomly assigned to either the GSCU or a traditional adult medical/surgical unit; outcomes were studied through questionnaires and medical record data. Researchers anticipated improved functional ability, less frequent use of restraints, fewer complications, shorter lengths of stay, and less frequent readmission to the hospital or admission to nursing homes for GSCU patients. The article presents preliminary results, discusses implementation issues, and describes plans for continued study.