Effect of Hurricane Irma on daily direct-care nurse staffing in nursing homes.

OBJECTIVES: To examine the effect of Hurricane Irma on staff-related financial expenditures and daily direct-care nurse staffing levels. DESIGN: Retrospective cohort study. SETTING: September 3-24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. PARTICIPANTS: Six hundred and fifty-three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered-in-place. MEASUREMENTS: This study used data from Payroll-Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct-care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility-level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed-effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. RESULTS: Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3-24), an additional estimated $2.41 million was spent on direct-care nurse staffing. In comparison to facilities that sheltered-in-place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered-in-place spent $76.10 on nurse staffing per resident. CONCLUSION: NHs face unprecedented challenges during hurricanes, including maintaining adequate direct-care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct-care nurse staffing that was greater than that seen in NHs that sheltered-in-place.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in.

OBJECTIVES: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. METHOD: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. RESULTS: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. CONCLUSIONS: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

Validation of an Instrument to guide Nursing Staffing in Obstetric Rooming in / Validación de Instrumento para fundamentar dimensionamiento de Profesionales de Enfermería em Alojamiento Conjunto / Validação de Instrumento para fundamentar dimensionamento de Profissionais de Enfermagem em Alojamento Conjunto

ABSTRACT Objectives: to construct and validate an instrument for the classification of mother-baby binomials that subsidizes personnel Staffing in in-rooming units. Method: methodological study. The construction was based on theoretical and legal references. Content validity was performed by experts through the content validity index measurement. Then, the instrument was applied to a sample of 122 binomials, and exploratory factor analysis was performed using the principal components analysis. Results: the instrument consisted of seven care indicators: Birth route; Maternal morbidity; Neonatal morbidity; Breastfeeding; Social aggravating factors; Care guidance; and interaction and bonding. All with content validity index of 1. The construct was composed of 3 domains, with Cronbach's alpha of 0.62, 0.85 and 0.89. Conclusions: the classification instrument of mother-baby binomials allows the classification of mother-baby binomials and may support personnel Staffing in in-rooming units.

RESUMEN Objetivos: elaborar y validar un instrumento para clasificación de binomios puerperio neonatal que subsidie el dimensionamiento de personal en unidades de alojamiento conjunto. Métodos: estudio metodológico. La construcción ha sido basada en referencias teóricas y legales. La validez de contenido ha sido realizada por expertos por medio de medición del índice de validez de contenido. Luego, el instrumento ha sido aplicado en una muestra de 122 binomios, y ha sido realizado análisis factorial exploratoria por el método de componentes principales. Resultados: el instrumento ha quedó constituido por siete indicadores de cuidado: Vía de parto; Morbilidad materna; Morbilidad neonatal; Amamantamiento; Agravantes sociales; Orientación de cuidados; e Interacción y vínculo. Todos con índice de validez de contenido iguales a 1. El constructo ha sido compuesto por 3 dominios, con Alfa de Cronbach de 0,62, 0,85 y 0,89. Conclusiones: el instrumento para la clasificación de binomios puerperio neonatal permite la clasificación de binomios puerperio neonatal y podrá basarse el dimensionamiento de personal en alojamiento conjunto.

RESUMO Objetivos: construir e validar um instrumento para classificação de binômios puérpera-neonato que subsidie o dimensionamento de pessoal em unidades de alojamento conjunto. Métodos: estudo metodológico. A construção foi embasada em referenciais teóricos e legais. A validade de conteúdo foi realizada por expertos por meio de mensuração do índice de validade de conteúdo. Em seguida, o instrumento foi aplicado em uma amostra de 122 binômios, e foi realizada análise fatorial exploratória pelo método de componentes principais. Resultados: o instrumento ficou constituído por sete indicadores de cuidado: Via de parto; Morbidade materna; Morbidade neonatal; Aleitamento; Agravantes sociais; Orientação de cuidados; e Interação e vínculo. Todos com índice de validade de conteúdo iguais a 1. O constructo foi composto por 3 domínios, com Alfa de Cronbach de 0,62, 0,85 e 0,89. Conclusões: o instrumento para a classificação de binômios puérpera-neonato permite a classificação de binômios puérpera-neonato e poderá embasar o dimensionamento de pessoal em alojamento conjunto.

Multidrug-resistant bacteria infection and nursing quality management application in the department of physical examination.

The main problem of clinical prevention and control of multi drug resistant bacteria infection is to strengthen the monitoring of pathogenic bacteria spectrum, this study research on the multi drug-resistant bacteria infection and nursing quality management application in the department of physical examination. The results of this study showed that the number of patients with multiple drug resistant infections showed an increasing trend. Therefore, once the patients with multiple drug-resistant bacteria infection are found, the prevention and control of the patients with multiple drug-resistant bacteria should be strictly followed, and the patient's medication care should be highly valued. Also, the nurses need to be classified based on the knowledge and skill characteristics of the nurses in the department of physical examination, and compare the nursing effect before and after classification and grouping. The physicians and individuals receiving physical examinations in the department of physical examination had a higher degree of satisfaction for nursing effect after classification compared with those before classification. Classification and grouping management helps improve the nursing quality and overall quality of the nurses in the department of physical examination.

Variation in job titles within the nursing workforce.

AIMS AND OBJECTIVES/BACKGROUND: The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population. METHODS: A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis. RESULTS: Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council. RELEVANCE TO CLINICAL PRACTICE: In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.

Análisis de la importancia del programa de donación de sangre de cordón umbilical y su relación con la información ofrecida por el personal sanitario / Analysis of the importance of the blood donation program of umbilical cord and its relation with the infomation given by the health workers

La sangre de cordón umbilical (SCU) ofrece una fuente rica de células progenitoras hematopoyéticas, caracterizadas por su capacidad de proliferación, diferenciación y renovación celular de los tejidos sobre los que se encuentran. Los beneficiarios de esta donación son todas aquellas personas con enfermedades de la médula ósea. Desde que en el año 1988 se realizara con éxito el primer trasplante de sangre de cordón umbilical entre hermanos HLA idénticos, se han llevado a cabo numerosas donaciones, de manera que, actualmente, cualquier mujer que dé a luz en alguno de los centros autorizados para ello de nuestro país podrá donar, de forma voluntaria, este material hematopoyético al Banco de Cordón Umbilical más cercano del cual dependa su comunidad. La puesta en marcha del protocolo de recogida de muestras ha sido y es una tarea difícil que ha precisado de formación, motivación y colaboración tanto interprofesional como entre distintos niveles asistenciales, además de suponer un esfuerzo que consideramos aún poco difundido (AU)

Umbilical Cord Blood has a rich source of haematopoietic progenitor cells (HSC) characterized by their capacity for proliferation, differentiation and cell renewal of tissues on which they are located. The beneficiaries of this donation are all these people with diseases of the bone marrow. Since the year 1988 will be held the first successful transplantation of umbilical cord blood from HLA-identical siblings, have conducted numerous donations, so that, today, any woman who gives birth in any of the centers authorized may donate voluntarily to this material hematopoietic to the Cord Blood Bank which depends their community. Sample collection, has been and is a difficult task that has required training, motivation and collaboration both interprofessional and between different levels of care, while making an effort to consider an information still little known (AU)

Sick leave in the emergency department: staff attitudes and the impact of job designation and psychosocial work conditions.

AIM: To examine patterns of, and attitudes to, sick leave taken by ED and other hospital staff and to compare ED doctor and nurse psychosocial work conditions. METHODS: This was an observational study in a tertiary referral ED. An audit of sick leave taken over a 2-year period (2007-2008) by all ED, general medicine (GM) and pharmacy pay groups was undertaken. This was followed by a cross-sectional survey of ED staff. It evaluated attitudes towards sick leave and used the Karasek's Job Content Questionnaire to assess psychosocial work conditions. RESULTS: Overall, sick leave taken by the various staff groups differed significantly (P < 0.01). The ED and GM nurse rates (6.0% and 5.9%, respectively) were approximately twice that of pharmacists (3.3%) and ED allied health staff (3.1%) and more than three times that of all doctor groups (range 1.3-1.9%). ED registrars and nurses tended to take more leave on Monday/Tuesday and Thursday/Friday, respectively. These groups also tended to take more leave in winter/early summer and autumn/spring, respectively. In total, 147 (93.0%, 95% CI 87.6-96.0) ED staff rarely/never took sick leave without being sick. However, 15 (9.5%, 95% CI 5.6-15.5) often/very often took sick leave because of work stress. Compared with ED nurses, ED doctors had significantly more job insecurity and supervisor support but less psychological job demand (P < 0.05). CONCLUSIONS: Emergency department staff generally report healthy psychosocial work conditions. However, the high rate of ED nurse sick leave might be related to their considerable psychological job demand and perceived lack of supervisor support.

A measure of palliative care in nursing homes.

CONTEXT: Efforts to improve care for nursing home residents stand to be enhanced by measures to assess the degree to which staff provide palliative care. As the incidence of death in nursing homes increases with the aging population, the gap in measurement must be addressed. To that end, we report the development and psychometric testing of a nursing home palliative care survey. OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of the Palliative Care Survey (PCS) for use in nursing homes. METHODS: Psychometric evaluation of the instrument was completed in two phases. Phase 1 focused on individual item analyses and subsequent revision or deletion of items, and Phase 2 evaluated evidence for reliability and validity. Phase 1 included 26 nursing homes and staff (n=717), and Phase 2 included 85 nursing homes and staff (n=2779). Data were analyzed using item-total correlations, Cronbach's alpha, confirmatory factor analysis, and analysis of variance. RESULTS: Support was obtained for a 51-item PCS made up of two constructs, Palliative Care Practice and Palliative Care Knowledge. CONCLUSION: The PCS measures the extent to which the nursing home staff engage in palliative care practices and have knowledge consistent with good end-of-life care. Both practice and knowledge are an essential foundation to providing good end-of-life care to nursing home residents. Efforts to improve care for the dying in nursing homes have been slowed by an absence of measurement tools that capture care processes, a gap that the PCS reported here helps fill.

Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents.

BACKGROUND: Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nursing home characteristics. PURPOSE: The purpose of this study was to elucidate the intertwined relationships between Medicaid census and other important nursing home factors and its impact on psychosocial care for residents. This study examined the interactive effects of (1) nursing home ownership status and Medicaid census, (2) staffing level and Medicaid census, and (3) resident ethnic mix and Medicaid census on psychosocial well-being outcomes. METHODOLOGY: The sample, derived from a combined data set of New York State nursing homes' Online Survey Certification and Reporting System and Minimum Data Set, included 565 nursing homes in rural and urban areas of the state. FINDINGS: Medicaid census had no main effect on psychosocial well-being outcomes of nursing home care but had a significant interactive effect with other nursing home characteristics. High Medicaid census was associated with lower level of psychosocial symptom detection in nonprofit nursing homes and nursing homes with a higher proportion of ethnic minority residents. PRACTICE IMPLICATIONS: Nursing staff training on better psychosocial well-being care, in particular, better psychosocial assessment, is important. To obtain the training resources, nursing homes with high Medicaid census can collaborate with other nursing homes or social service agencies. Considering that nursing homes with a high proportion of ethnic minority residents have lower level of detection rate for psychosocial well-being issues, culturally competent care should be a component of quality improvement plans.

Family practice registered nurses: The time has come.

OBJECTIVE: To provide a picture of the unique role and competencies of family practice registered nurses (FP-RNs). DESIGN: Case-study approach using interviews and focus groups. SETTING: Ontario. PARTICIPANTS: Seven FP-RNs identified as exemplary by family medicine and nursing peers. METHODS: An e-mail was sent to 9200 health care providers from nursing and family medicine, asking them to identify names of exemplary family practice nurses. Using a purposive sampling methodology, 7 exemplary FP-RNs were selected, taking into consideration the number of years in practice as a nurse, location of practice, length of practice as an FP-RN, and type of family practice. Individual interviews were held, and focus groups were organized with colleagues. Narratives were analyzed iteratively by the project team. MAIN FINDINGS: Four main themes emerged: The first theme relates to the relationship-centred approach to care delivered by FP-RNs, founded upon trust. The second theme highlights the FP-RN's unique skills in balancing the priorities of patients, colleagues, and the clinic as a whole. The third theme capitalizes on the nurses' commitment to advancing their learning to enhance their abilities to be FP-RNs. The fourth theme illuminates the perspectives shared by FP-RNs that family practice is uniquely different from acute care in the manner in which care is delivered. We draw attention to the approach and role of FP-RNs in Ontario. The 4 themes that emerged have striking similarities to stories shared by family physicians and to the evolutionary development of the discipline of family medicine. CONCLUSION: We believe the findings from this paper can help shape the role of the FP-RN within clinical practice and that they will propagate discussion among nursing educators to consider the necessary educational preparation required to develop the FP-RNs needed in this country.

We're on the same side: improving communication between nursing home and family.

Good communication between families and care providers is central to quality care, providing valuable insight into medical history and preferences, increasing family involvement and satisfaction, and reducing complaints. Two studies offer insight into sources of family-staff miscommunication and conflict. The Nursing Home Family Study (Study 1) interviewed 103 family caregivers to nursing home residents. The Long Term Care Community Coalition (Study 2) conducted focus groups and surveys with staff in six facilities: 323 certified nurse's assistants, 52 licensed practical nurses, and 71 registered nurses. Qualitative and quantitative data from both studies identified multiple barriers to good communication associated with both nursing homes and family caregivers. Institutional barriers include understaffing, turnover, inadequate training, policies based in a medical model, rigid routines, poor intrastaff communication, and work schedules that do not coincide with family visits. Psychosocial factors that hinder family communication include guilt, role confusion, clashes of culture and values, unrealistic expectations, and conflicting responsibilities. Specific communication problems identified by families were: making them feel guilty, criticism of their involvement, lack of information, changes made without consultation, staff have too little time to talk, high turnover, rotating shifts, and poor intrastaff communication. Similar issues were raised by nursing staff, who valued trusting, respectful relationships with supervisors and families, being consulted prior to changes, support in addressing racist or abusive comments, adequate staffing, and teamwork. Certified nursing assistants noted that family members are quick to complain but seldom offer praise, and that their intimate knowledge of the resident is rarely acknowledged. These data are applied to develop educational interventions to improve family-staff communication.

A national view of workplace injuries in nursing homes.

OBJECTIVES: Data from a large sample of nursing homes were used to examine the cross-sectional association between workplace injuries and organizational factors, caregiver staffing levels, and quality. METHODS: Three sources of data were used, the Occupational Safety and Health Administration data initiative for 2004, the Online Survey Certification and Recording system representing 2004, and the 2004 Area Resource File. RESULTS: For the organizational characteristics of interest, the results show that for-profit facilities were less likely to report high injury rates and that facilities with a higher average occupancy and belonging to a chain were more likely to report high injury rates. For the staffing characteristics of interest, facilities with high staffing levels of registered nurses were more likely to report high injury rates, whereas those with high staffing levels of nurse aides were less likely to report high injury rates. For the quality characteristic of interest, facilities of low quality (as measured by quality-of-care deficiency citations) were more likely to report high injury rates. CONCLUSIONS: Workplace injuries are associated with organizational, caregiver, and quality characteristics of nursing homes. This may present an opportunity to reduce high injury rates.

Organizational and environmental effects on voluntary and involuntary turnover.

BACKGROUND: There are few studies of voluntary and involuntary turnover in the nursing home literature. Previous research in this area has focused mainly on the linear effects of individual and organizational characteristics on total turnover. PURPOSES: The purpose of this study was to examine both linear and nonlinear effects of organizational and environmental conditions on voluntary and involuntary nursing home staff turnover. METHODOLOGY/APPROACH: We analyzed both primary and secondary data on 854 nursing homes in six states. A negative binomial regression model was used to study both linear and curvilinear effects of organizational and environmental factors on voluntary and involuntary turnover among registered nurses, licensed practical nurses, and nurse aides. FINDINGS: Staffing levels and deficiency citations were the organizational characteristics most consistently linked with turnover among all nurse types. Links were also found between unemployment and type of location (urban or rural) and turnover, indicating that the economic environment is influential for retention. PRACTICE IMPLICATIONS: The results of this study support the notion that policy makers need to consider both the organization and the environment when evaluating the nature of nursing home staff turnover. The findings also offer further evidence that the antecedents of voluntary and involuntary turnover are not necessarily the same.

Tasks performance by registered nurses and care assistants in nursing homes: a quantitative comparison of survey data.

OBJECTIVES: To examine the care tasks performed for residents of Belgian care institutions for older people and the association between the performance of care tasks by persons of different staffing categories (registered nurses (RN) and care assistants (CA)) and the characteristics (the dependency level and the diagnosis of dementia) of the residents. STUDY DESIGN AND SETTING: Survey on the care for residents, aged 65 or over, living in 26 care institutions for aged people. MAIN OUTCOME MEASURES: Separate bivariate comparisons of care time spent on residents with and without dementia and bivariate comparisons of care time spent on six task categories on residents of different dependency levels were performed. The median number of minutes over seven days (mosd) and the inter quartile range (IQR) are presented as summary measures. The proportion of the time spent by RNs and CAs per resident and per task category was calculated. RESULTS: Time spent was highest on primary care tasks (34,554 mosd; 48.7%), followed by in order of time spent, supportive tasks (10,845 mosd; 15.3%), logistic tasks (10,697 mosd; 15.1%), practical nursing procedures (8,689 mosd; 12.2%), administrative tasks (3,357 mosd; 4.7%) and communication tasks (2,814 mosd; 4.0%). Overall there was no significant difference between the total time spent by RNs (median=190 mosd; IQR 105-334) and the total time spent by CAs (median=196 mosd; IQR 91-331; p=0.89). RNs were spending significantly more time than CAs in practical nursing procedures, communication tasks and administrative tasks. CONCLUSIONS: There was a sharp task demarcation between RNs and CAs in the three less frequent task categories. There was no indication that RNs were delegating tasks to CAs.

Resident care needs and work stressors in special care units versus non-specialized long-term care units.

Differences in how elderly residents' care needs affect staff's experiences of work stressors between special care units (SCUs) for dementia and psychiatric residents and non-SCUs were investigated. The data were drawn from 390 staff members in 38 long-term care SCUs, and 587 staff in 53 non-SCUs in Finland. Residents' care needs were based on the Resident Assessment Instrument (RAI) system measured by the Minimum Data Set 2.0. Work stressors (time-pressure and role-conflicts) were assessed with a staff survey questionnaire. Multiple-group regression analysis showed that residents' dependency in activities of daily living (ADL) was related to increased work stressors only in SCUs. A high proportion of behavioral problems was related to fewer work stressors for SCU staff, but more for non-SCU staff. Work stressors may be reduced by specializing, so that residents with similar care needs are placed together and care is focused.

An exploration of job design in long-term care facilities and its effect on nursing employee satisfaction.

This study used quantitative and qualitative methods to examine the design of nursing jobs in long-term care facilities and the effect of job design on employee satisfaction.