Implementing the differentiated pay structure model. Process and outcomes.

OBJECTIVE: A salaried Differentiated Pay Structure (DPS) model based on the work of Dr. Virginia Cleland was tested on two units. The project objectives were to: 1) create a budget-neutral compensation distinction for different competencies and educational levels; 2) evaluate the effect of the new salaried model on unit costs and pay; 3) determine the effect of the DPS model on job satisfaction, organizational commitment, and anticipated turnover; and 4) assess the impact of professional commitment, professional practice climate, perception of staffing adequacy, and dispositional optimism on job satisfaction, organizational commitment, and anticipated turnover. BACKGROUND: Although there has been long-standing interest in salaried models and reward methodologies, there is a dearth of systematic research associated with specific compensation models. METHODS: A quasi-experimental, non-equivalent control group design was used to examine the effects of the DPS model. RESULTS: Findings demonstrated that nurses were paid more under the DPS model, and that they were paid for more hours than they actually worked (N = 68). No difference in job satisfaction was found between experimental and control groups. For all nurses (N = 232) dispositional optimism was associated with all job satisfaction subscales except pay. Organizational commitment, professional commitment, professional practice climate, and staffing adequacy were also correlated with job satisfaction, perceptions of care quality and anticipated turnover. Older nurses who had worked longer in nursing, and who had more tenure were less satisfied with their coworkers and care quality. CONCLUSION: Further longitudinal research with larger experimental samples is required in order to fully understand the effects of the DPS model in nursing.

Research-based planning for change: assessing nurses' attitudes toward governance and professional practice autonomy after hospital acquisition.

OBJECTIVE: This article describes one medical center's experience in using research to plan for nursing staff integration after hospital acquisition. BACKGROUND: Resistance to new policies, procedures, and standards; passive acceptance of new leadership; limited support for management plans; and failure to integrate with new nursing units are common staff reactions after acquisitions. Little has been written regarding which key staff variables to assess after acquisitions and how to use this data to plan for change. Structural contingency and attribution theory were used to guide leadership staff's assessment of acquired staff attributes to determine their congruence with concepts valued by the acquiring organization. METHODS: Qualitative and quantitative data were collected using a survey method. All 141 registered nurses and licensed practical nurses of the acquired medical center received a mailed survey. Sixty-six completed surveys were returned through the U.S. mail. No identifying information was placed on the survey to assure anonymity. RESULTS: The survey results described nurses perceptions of the advantages, concerns, and suggestions for a smooth transition after acquisition. In addition, the results clarified that nurses in the newly acquired hospital preferred a shared governance structure (congruent with the acquiring medical center's values) and the nurses perceived professional nursing autonomy was similar to that of nurses who worked at the acquiring medical center. CONCLUSIONS: By sharing the findings, both staffs were sensitized to the similarities among the staff as well as to their differences. Transition strategies were planned to capitalize on this knowledge. This process may be useful for other nurse executives to replicate as they guide their organizations through similar transitions.

Development and evaluation of a shipping system for platelet components.

BACKGROUND: Platelet concentrates and apheresis platelets must be maintained at a temperature as close as possible to 20 to 24 degrees C during transport. To improve temperature control, ensure component quality, and meet handling and freight carrier needs, a new insulated shipping container system was developed and evaluated. STUDY DESIGN AND METHODS: Molded polyurethane-insulated shipping containers were loaded with different payloads of simulated platelet components, with or without gel-based temperature stabilizing packs (TSPs). The containers were subjected to constant ambient temperature of 37, 4 or -10 degrees C. Payload temperatures were continuously monitored, in situ, for 24 hours. RESULTS: Temperature data are reported as the mean number of hours needed for components to warm or cool by 1 degree C. The temperature of payloads exposed to a constant 37 degrees C ambient temperature increased by 1 degree C in 2.5 to 3.8 hours when no TSPs were included in the shipment and in 6.1 to 6.9 hours when TSPs were used. Exposure to a constant 4 degrees C ambient temperature resulted in a 1 degree C temperature decrease in 1.8 to 3.4 hours without TSPs and in 4.6 to 5.6 hours with TSPs. At a -10 degrees C ambient temperature, there was a 1 degree C drop within 1.0 to 1.6 hours without TSPs and within 2.7 to 2.9 hours with TSPs. CONCLUSION: The container and packing methods described moderate the rate of change in the temperature of platelet components during their exposure to challenging ambient conditions. The use of TSPs substantially improves the performance of the system. In addition, the system meets freight carrier requirements and is easy to use, environmentally friendly, and durable.

Effect on platelet properties of exposure to temperatures below 20 degrees C for short periods during storage at 20 to 24 degrees C.

BACKGROUND: When platelet concentrates (PCs) are shipped over long distances, it is not always possible to ensure that their temperature is maintained at 20 to 24 degrees C. In addition, PCs are not agitated as during routine storage. STUDY DESIGN AND METHODS: Studies have been conducted to evaluate how exposure to temperatures below 20 degrees C in the absence of agitation influences properties of platelets. In initial studies, exposure to 4 degrees C for 3 or 5 hours or to 12 degrees C for 5 or 17 hours on Day 2 of a 5- to 6-day storage period was associated with a loss of discoid shape. This was reflected by slightly lower but statistically different morphology scores after storage compared to those observed with control platelets that were stored only at 20 to 24 degrees C. In addition, a qualitative difference in morphology was noted in controls and PCs held at 16 degrees C for 17 hours. In more detailed studies, both the in vivo viability and in vitro properties of platelets exposed between Day 1 and Day 2 to either 12 degrees C or 16 degrees C for 17 hours were evaluated. The protocol involved a paired study design (n = 4 for each exposure temperature) with the simultaneous storage of two identical PCs, one exposed to 12 or 16 degrees C and the other one maintained at 20 to 24 degrees C throughout the 5-day storage. RESULTS: Exposure to 12 degrees C significantly reduced (p < 0.05 by paired t test) the in vivo recovery to 37.6 +/- 13.8 percent (mean +/- 1 SD) from 47.8 +/- 11.5 percent and the survival time to 2.0 +/- 0.3 days from 6.5 +/- 1.4 days. On exposure to 16 degrees C, the differences in viability from those of control units were much less but still significant. The in vivo recovery was 42.7 +/- 3.8 percent compared to 49.2 +/- 3.0 percent and the survival time was 3.5 +/- 1.2 days compared to 6.6 +/- 0.3 days. The loss of in vivo viability of the test platelets was associated with a loss of discoid shape, as reflected by morphology scores, extent of shape change, and mean platelet volume. In addition, platelet metabolism also appeared to be affected, as suggested by increased lactate production. All of the in vitro properties except for total ATP and residual glucose that were statistically different from those of controls on exposure to 12 degrees C were also significantly different on exposure to 16 degrees C. CONCLUSION: These findings demonstrate that platelets undergo substantial changes in in vivo viability and in vitro properties when they are exposed to temperatures below 20 degrees C for short periods.

The maintenance of platelet properties upon limited discontinuation of agitation during storage.

Platelet concentrates are routinely stored with continuous agitation but may need to be maintained without agitation for substantial time periods. Studies were conducted in vitro to assess the retention of platelet properties after the discontinuation of agitation. Platelets were maintained without agitation in an insulated cardboard container. In one study, platelet concentrates were kept at 20 to 24 degrees C for the entire 24-hour period. In another study, they were kept at 37 degrees C for 6 hours with subsequent storage at ambient room temperature for the remainder of the 24-hour holding period. Under the simulated shipping conditions, discontinuation of agitation for 24 hours between Days 2 and 3 of a 7-day storage period minimally influenced the maintenance of a series of in vitro platelet properties. The maintenance of platelet concentrates at 20 to 24 degrees C, sitting undisturbed on a bench top for 9 hours, after storage for 6 days with continuous agitation, also had no damaging influence.

The influence of irradiation on stored platelets.

Platelet concentrates intended for transfusion to immunosuppressed patients are irradiated to minimize transfusion-induced graft-versus-host disease. Because few reports describe how irradiation influences stored platelets, the authors studied whether 5000 rad of gamma irradiation, the maximum dose currently used clinically, altered platelets in vitro. Platelet concentrates were stored for either 1 day or 5 days in plastic (PL 732) containers before gamma irradiation. One unit of a pair of identical platelet concentrates was irradiated; the second unit served as a control. Irradiation did not alter platelet morphology, mean platelet volume, expression of platelet-factor-3 activity, response to hypotonic stress, extent of discharge of lactate dehydrogenase, release of beta-thromboglobulin, formation of thromboxane B2, nor the ability to undergo synergistic aggregation. The lack of any substantial change was observed whether the platelet concentrates were stored initially for either 1 day or 5 days. These results suggest that stored platelets are not altered deleteriously by irradiation with 5000 rad.