RESUMEN
BACKGROUND: The United Kingdom and the United States are among several developed countries currently experiencing nursing shortages. While the USA has not yet implemented policies to encourage nurse immigration, nursing shortages will likely result in the growth of foreign nurse immigration to the USA. Understanding the factors that drive the migration of nurses is critical as the USA exerts more pull on the foreign nurse workforce. AIM: To predict the international migration of nurses to the UK using widely available data on country characteristics. METHOD: The Nursing and Midwifery Council serves as the source of data on foreign nurse registrations in the UK between 1998 and 2002. We develop and test a regression model that predicts the number of foreign nurse registrants in the UK based on source country characteristics. We collect country-level data from sources such as the World Bank and the World Health Organization. RESULTS: The shortage of nurses in the UK has been accompanied by massive and disproportionate growth in the number of foreign nurses from poor countries. Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the UK. CONCLUSION: Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labour. This tendency is currently exacerbated by nursing shortages in developed countries. Countries at risk for nurse emigration should adjust health sector planning to account for expected losses in personnel. Moreover, policy makers in host countries should address the impact of recruitment on source country health service delivery.
Asunto(s)
Emigración e Inmigración/estadística & datos numéricos , Personal Profesional Extranjero/provisión & distribución , Personal de Enfermería/organización & administración , Selección de Personal/organización & administración , Factores de Edad , Países Desarrollados , Países en Desarrollo , Predicción , Planificación en Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Renta , Análisis de los Mínimos Cuadrados , Análisis Multivariante , Investigación en Administración de Enfermería , Densidad de Población , Pobreza , Valor Predictivo de las Pruebas , Sistema de Registros , Salarios y Beneficios , Reino Unido , Estados UnidosRESUMEN
The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.
Asunto(s)
Actitud del Personal de Salud , Personal de Enfermería en Hospital/psicología , Calidad de la Atención de Salud , Agotamiento Profesional , Canadá , Países Desarrollados , Inglaterra , Alemania , Investigación sobre Servicios de Salud , Humanos , Satisfacción en el Trabajo , Personal de Enfermería en Hospital/provisión & distribución , Pennsylvania , Escocia , Carga de TrabajoAsunto(s)
Gastos en Salud/estadística & datos numéricos , Recursos en Salud/economía , Evaluación de Necesidades/economía , Enfermería/organización & administración , Canadá , Análisis Costo-Beneficio , Medicina Basada en la Evidencia , Predicción , Gastos en Salud/tendencias , Recursos en Salud/tendencias , Humanos , Modelos Econométricos , Evaluación de Necesidades/tendencias , Investigación en Evaluación de Enfermería , Admisión y Programación de Personal/economía , Admisión y Programación de Personal/normas , Admisión y Programación de Personal/tendencias , Estados UnidosRESUMEN
According to most experts, the U.S. faces a growing shortage of registered nurses, threatening the quality of care hospitals can provide. In the setting of nurse shortages and simultaneous concern about patient safety, nurses' job satisfaction and their assessment of quality of care become critical. This Issue Brief highlights a cross-national survey that describes nurses' perceptions of their hospital work environment, and identifies core problems in work design and workforce management in five countries.
Asunto(s)
Administración Hospitalaria , Satisfacción en el Trabajo , Investigación en Enfermería , Enfermería , Canadá , Europa (Continente) , Política de Salud , Reestructuración Hospitalaria , Humanos , Moral , Enfermeras y Enfermeros , Admisión y Programación de Personal , Calidad de la Atención de Salud , Estados Unidos , Recursos HumanosRESUMEN
OBJECTIVE: To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care. METHODS: Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses. RESULTS: Mortality was lower and satisfaction was higher for AIDS patients in dedicated AIDS units and in nursing magnet hospitals. Primary nursing, end-of-life care counseling, and discharge planning were also more common. Higher nurse to patient ratios and AIDS physician specialty services were strongly associated with lower mortality. Patient satisfaction was strongly associated with organizational control of care by bedside nurses. Homosexuals were more likely to be admitted to dedicated AIDS units, which largely explains the under-representation of minorities and women. CONCLUSIONS: Dedicated AIDS units and magnet hospitals offer important benefits to AIDS patients, including lower odds on dying within 30 days of admission, higher patient satisfaction, and care meeting professional standards. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses improve patient outcomes.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Unidades Hospitalarias/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Benchmarking , Femenino , Mortalidad Hospitalaria , Unidades Hospitalarias/normas , Humanos , Masculino , Oportunidad Relativa , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Estados Unidos/epidemiologíaAsunto(s)
Administración Hospitalaria/normas , Evaluación de Resultado en la Atención de Salud , Calidad de la Atención de Salud , Canadá , Control de Costos , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud/métodos , Mortalidad Hospitalaria , Humanos , Servicio de Enfermería en Hospital/organización & administración , Servicio de Enfermería en Hospital/normas , Pennsylvania , Escocia , Resultado del Tratamiento , Recursos HumanosRESUMEN
The label "magnet hospitals" originally was given to a group of U.S. hospitals that were able to successfully recruit and retain professional nurses during a national nursing shortage in the early 1980s. Studies of magnet hospitals illuminated the leadership characteristics and professional practice attributes of nurses within these organizations. Recent investigations within magnet hospitals document significant relationships between nursing and patient outcomes, including mortality and patient satisfaction. The purpose of this review is to: 1) synthesize the magnet hospital research that describes and evaluates the professional practice of nurses within these institutions and (2) identify areas for future research to advance professional nursing models within current hospital organizations.
Asunto(s)
Benchmarking , Administración Hospitalaria/normas , Personal de Enfermería en Hospital/normas , Calidad de la Atención de Salud , Actitud del Personal de Salud , Humanos , Liderazgo , Enfermeras Administradoras/organización & administración , Enfermeras Administradoras/normas , Personal de Enfermería en Hospital/organización & administración , Evaluación de Resultado en la Atención de Salud , Estados UnidosRESUMEN
ISSUES AND PURPOSE: The number of uninsured children has been growing at an alarming rate. The most vulnerable children are those in lower-income families who are falling through the cracks between evolving government-sponsored health insurance programs. Recent policy initiatives may not be adequate to extend coverage to more children. CONCLUSIONS: Many low-income children actually are eligible for Medicaid but are not enrolled for a variety of reasons. The numbers of these children have risen due to welfare reform. Better outreach efforts are needed to ensure that new child health insurance programs and Medicaid expansions achieve their goals. IMPLICATIONS FOR PRACTICE: A comprehensive assessment of insurance status and referral to community agencies should be an integral part of patient care for all healthcare providers.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Pacientes no Asegurados , Niño , Determinación de la Elegibilidad , Humanos , Servicios de Información , Internet , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Enfermería Pediátrica , Pobreza , Gestión de la Calidad Total/organización & administración , Estados UnidosRESUMEN
The establishment of AIDS hospitals and AIDS units within hospitals has been controversial. Unlike other specialty care, AIDS care arrangements were initially developed as much to segregate AIDS patients from other patients and staff as to provide the best possible care. Ten years after many of these units opened, little evidence was available about whether the benefits of aggregating AIDS patients outweighed the potential hazards of segregating people from the mainstream of hospital care. This Issue Brief describes a national study to determine how different organizational settings affect the outcomes of inpatient AIDS care.
Asunto(s)
Evaluación de Procesos y Resultados en Atención de Salud/organización & administración , Síndrome de Inmunodeficiencia Adquirida/terapia , Atención a la Salud , Política de Salud , Mortalidad Hospitalaria , Unidades Hospitalarias , Humanos , Satisfacción del Paciente , Estados UnidosRESUMEN
Industry-wide health sector reforms in the United States, Canada, and Europe have provided a unique opportunity to examine the effects of hospital restructuring on inpatient nursing care and patient outcomes across an array of settings. Seven interdisciplinary research teams--1 each in Alberta, British Columbia, England, Germany, Ontario, Scotland, and the United States--have formed an international consortium whose aim is to study the effects of such restructuring. Each site has enrolled large numbers of hospitals and nurses to explicate the role that organization of nursing care, a target of hospital restructuring, plays in differential patient outcomes. The study seeks to understand more fully the influence of both nurse staffing and the nursing practice environment on patient outcomes. Discussion of the theoretical foundation, study design, and process of developing the study instruments and measures illustrates the process to date, as well as the feasibility of and opportunities inherent in such an international endeavour.
Asunto(s)
Reestructuración Hospitalaria/organización & administración , Cooperación Internacional , Estudios Multicéntricos como Asunto/métodos , Investigación en Administración de Enfermería/organización & administración , Personal de Enfermería en Hospital/provisión & distribución , Evaluación de Resultado en la Atención de Salud , Admisión y Programación de Personal/organización & administración , Alberta , Colombia Británica , Inglaterra , Alemania , Humanos , Ontario , Innovación Organizacional , Escocia , Estados UnidosAsunto(s)
Atención a la Salud/tendencias , Innovación Organizacional , Calidad de la Atención de Salud , Canadá , Ahorro de Costo , Atención a la Salud/normas , Europa (Continente) , Hospitales/tendencias , Satisfacción en el Trabajo , Enfermeras y Enfermeros/provisión & distribución , Reino Unido , Estados UnidosAsunto(s)
Reestructuración Hospitalaria/organización & administración , Estudios Multicéntricos como Asunto , Investigación en Enfermería/organización & administración , Personal de Enfermería en Hospital/organización & administración , Evaluación de Resultado en la Atención de Salud/organización & administración , Mortalidad Hospitalaria , Humanos , Readmisión del Paciente , Proyectos de InvestigaciónAsunto(s)
Mortalidad Hospitalaria , Reestructuración Hospitalaria , Personal de Enfermería en Hospital/psicología , Evaluación de Resultado en la Atención de Salud , Síndrome de Inmunodeficiencia Adquirida/terapia , Actitud del Personal de Salud , Benchmarking , Reestructuración Hospitalaria/normas , Unidades Hospitalarias/organización & administración , Unidades Hospitalarias/normas , Humanos , Medicare/estadística & datos numéricos , Personal de Enfermería en Hospital/organización & administración , Innovación Organizacional , Estrés Psicológico , Estados Unidos , Recursos HumanosRESUMEN
OBJECTIVES: The rapidly changing organizational context within which health care is delivered is altering provider-patient relations and processes of clinical decision-making, with significant implications for patient outcomes. Yet definitive research on such effects is lacking. The authors seek to underscore the contribution of organizational research to studies of clinical outcomes and demonstrates several approaches to further such efforts. METHODS: The authors present a theoretical framework of the operant mechanisms linking organizational attributes and patient outcomes. They use case examples from their ongoing research on hospitals to illustrate strategies for measuring these mechanisms and for overcoming some of the feasibility issues inherent in organizational research. RESULTS: Several methodological issues are explored: (1) exploiting "targets of opportunity" and "natural experiments" is a promising strategy for studying patient outcomes related to organizational reform; (2) indices of organizational traits, constructed from individual survey responses, can illuminate the operant mechanisms by which structure affects outcomes; and (3) secondary data sources and innovative statistical matching procedures provide a feasible strategy for constructing study comparison groups. Extending the organizational outcomes research strategy to new areas of inquiry offers an opportunity to enhance our understanding of how nursing organization affects outcomes. CONCLUSIONS: Improving the effectiveness of medical care in a health-care system undergoing fundamental restructuring requires greater understanding of how organizational context affects clinical outcomes. A higher priority should be placed on organizational outcomes research by researchers and funding agencies.
Asunto(s)
Atención a la Salud/organización & administración , Investigación sobre Servicios de Salud/métodos , Investigación en Administración de Enfermería/métodos , Innovación Organizacional , Evaluación de Resultado en la Atención de Salud/métodos , Síndrome de Inmunodeficiencia Adquirida/enfermería , Actitud del Personal de Salud , Agotamiento Profesional , Reforma de la Atención de Salud , Administración Hospitalaria , Humanos , Modelos Teóricos , Servicio de Enfermería en Hospital/organización & administraciónRESUMEN
OBJECTIVES: This article describes the extent and nature of hospital restructuring across the United States, Canada, and Western Europe, countries with differently organized and financed health-care systems, and assesses the feasibility of international research on the outcomes of hospital restructuring. METHODS: The conceptual background, context, and focus for the Bellagio conference on Hospital Restructuring in North America and Western Europe held in November 1996 is provided, illustrating key issues on hospital and workforce trends using the US data with international comparisons. RESULTS: Hospital systems internationally are undertaking very similar restructuring interventions, particularly ones aimed at reducing labor expenses through work redesign. Nursing has been a prime target for work redesign, resulting in changes in numbers and skill mix of nursing staff as well as fundamental reorganizing of clinical care at the inpatient unit level. Yet little is known about the outcomes of such organizational interventions and there are few efforts in place to critically evaluate these actions. CONCLUSIONS: Restructuring of the hospital workforce and redesign of work in inpatient settings is widespread and markedly similar across North American and Europe, and warrants systematic study. Cross-national studies of the impact of restructuring inpatient care on patient outcomes would yield valuable lessons about the cost-quality tradeoffs in hospital redesign and re-engineering, as well as inform national planning about the numbers and types of nurses needed in the coming decades.