Professional characteristics and work attitudes of hospital nurses who leave compared with those who stay.

AIM: To compare characteristics and attitudes of nurses who resigned and those who remained in two Israeli hospitals and assess the reasons for leaving. BACKGROUND: Nurse turnover is a current global problem in health care system, especially given the severe nurse shortages. Retention of nurses requires an understanding of the characteristics of the resigning nurses, their attitudes and their reasons for leaving. METHODS: A matching case-control study was conducted among 100 resigning nurses and 200 matched remaining nurses. Questionnaires were used to survey the professional characteristics and attitudes of the participating nurses. In addition, exit interviews were used to assess the reasons to leave of resigning nurses. RESULTS: Resigning nurses had higher education, less seniority and fewer managerial positions compared with remaining nurses. In addition, resigning nurses had lower professional autonomy and higher aspirations for professional advancement. The reasons to leave cited by the resigning nurses were distance of the workplace from home and working conditions as well as aspiring for professional advancement. CONCLUSIONS: The interface between high education and having few opportunities for advanced positions may lead to resignation. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend organisational interventions for training new hospital nurses through professional career path development, such as mentoring programme.

Attitudes toward expanding nurses' authority.

BACKGROUND: In recent years, an increasing number of care procedures previously under the physician's authority have been placed in the hands of registered nurses. The purpose of this study was to examine the attitudes of nurses towards expanding nurses' authority and the relationships between these attitudes and job satisfaction facets, professional characteristics, and demographics. METHOD: A cross-sectional study was conducted between 2010 and 2011 in three major medical centers in Israel. Participants included 833 nurses working in 89 departments. Attitudes toward the expansion of nurses' authority were assessed by self-report questionnaire, as well as job satisfaction facets including perception of professional autonomy, nurse-physician working relations, workload and burnout, perceptions of quality of care, and nursing staff satisfaction at work. RESULTS: Nurses reported positive attitudes toward the expansion of nurses' authority and moderate attitudes for interpretation of diagnostic tests in selected situations. The results of multivariate regression analyses demonstrate that the nurses' satisfaction from professional autonomy and work relations were the most influential factors in explaining their attitudes toward the expansion of nurses' authority. In addition, professionally young nurses tend to be more positive regarding changes in nurses' authority. CONCLUSIONS: In the Israeli reality of a nurse's shortage, we are witnessing professional transitions toward expansion of the scope of nurses' accountability and decision-making authority. The current research contributes to our understanding of attitudes toward the expansion of nurses' authority among the nursing staffs. The findings indicate the necessity of redefining the scope of nursing practice within the current professional context.

The difference between professional image and job satisfaction of nurses who studied in a post-basic education program and nurses with generic education: a questionnaire survey.

To compare nurses' perceptions of the contribution of post-basic education (PBE) programs to nurses' professional image, job satisfaction, and clinical practice between two groups, nurses who had participated in PBE programs and nurses who had not. This is a cross-sectional study. A study conducted with 419 nurses employed in two major hospitals in Israel. Data were collected using structured questionnaires containing perception on professional self-image and clinical image, job satisfaction, and PBE contributions to nursing practice. Nurses who had completed a PBE in comparison to those who had not completed such a program rated higher the contribution of the program to independent decision making (40% and 50%, respectively, P < .001) as well as to specialized skills and proficiencies (38% and 55%, respectively, P < .01). Significant differences between the two groups were also found regarding professional image. Professional self-image and image of the clinical area were positively associated with professionalization. No differences regarding job satisfaction were found between the two groups. The study indicated that the model of PBE applied allows nurses to acquire greater self-confidence and improves professional self-image when making decisions. The model likewise helped nurses acquire greater authority to decide and intervene in clinical practice.

Risk factors for hepatitis C virus infection among blood donors in Israel: a case-control study between native Israelis and immigrants from the former Soviet Union.

BACKGROUND: The annual hepatitis C virus (HCV) seropositivity prevalence among blood donors (BDs) in Israel is 0.1 percent. Although only 10 percent of the BD population are immigrants from the former Soviet Union (FSUIs), they represent 80 percent of the HCV-seropositive cases. This study aimed to identify HCV risk factors among Native Israeli (NI) and FSUI BDs, to determine if specific interventions are needed. STUDY DESIGN AND METHODS: Two case-control studies were designed, interviewing 178 HCV-positive cases (128 FSUIs, 50 NIs) and 256 HCV-negative controls (128 FSUIs, 128 NIs). All participants were volunteer BDs of Magen David Adom (MDA) Blood Services. RESULTS: A total of 434 BDs of 985 mailed letters consented to be interviewed (44% response rate), without differences in compliance between the study populations. In both, intravenous drug use (IVDU) was the strongest HCV seropositivity-associated risk factor. After IVDU adjustment, important risk factors were age, blood transfusion before 1990, first-time donation, and not practicing teeth cleaning. Close contact with people at risk for HCV (odds ratio [OR], 7.2; 95% confidence interval [CI], 1.9-27.8) and surgery (OR, 7.3; 95% CI, 1.6-34.4) were strong risk factors among NIs, whereas gum surgery (OR, 7.6; 95% CI, 1.1-52.3), hospitalization without surgery (OR, 2.6; 95% CI, 1.1-6.5), and therapy in injection form (OR, 4.9; 95% CI, 2.4-10.2) were merely found among FSUIs, probably resulting from inadequate aseptic conditions. The ORs for age, gum surgery, contact index, and first blood donation differed significantly between the two populations. CONCLUSION: Although the strength of risk factors for HCV differs between Israeli and immigrant BDs, most factors studied did not differ between the groups. Therefore, changes in screening of all BDs are considered.

Patients' knowledge regarding medication therapy and the association with health services utilization.

BACKGROUND: Upon discharge from the hospital, patients are significantly deficient in their knowledge of their medications. Provision of information has been shown to have an effect on health measures such as compliance to medication therapy, quality of life, and utilization of hospitalization services. AIMS: To assess patients' knowledge about their long term medication therapy and to measure the association between knowledge and health service utilization in the community. METHODS: A prospective study was performed, with home telephone interviews conducted 1 week and 1 month after discharge. The study population included 130 patients discharged to the community with new prescriptions for long term medications. RESULTS AND CONCLUSIONS: About 60% of the patients reported receiving no counseling regarding their new medication. About 30% utilized 3 or more types of service (family physician, specialist, nurse, etc.). Eighteen percent (18%) visited the ER during the month after discharge, of whom 35% visited twice or more. Higher levels of patient knowledge predicted higher levels of health services utilization (OR=4.76 95% CI: 1.74-13.06). The younger patients tended to utilize a larger variety of health services compared to the older patients (OR 0.32 95% CI: 0.13-0.79). The results of this study provide that patients with higher levels of knowledge utilized the health care system more often, perhaps indicating greater awareness and self care.

What do discharged patients know about their medication?

Patient's knowledge is a necessity for empowering patients to perform self-care, especially when dealing with new, ill-defined and unknown situations. The aim of this paper is to assess patients' reported as opposed to correct knowledge about medication therapy after discharge from hospital and to identify factors that increase correct knowledge. Three hundred and forty-one patients were interviewed 7-14 days after discharge from six internal wards in a large medical facility in Israel. Most patients (73%) were aware of the course and purpose of their medication. They were, however, unaware of side effects, needed lifestyle changes, and correct medication schedules. A large difference was found between levels of reported and correct knowledge about various issues regarding medication treatment. No significant correlation was found between correct knowledge about medication therapy at discharge, and gender, age, education, patient satisfaction and wish for more counseling. The only factor which significantly affected levels of correct knowledge was whether the patient had received medication counseling during hospitalization. The findings illuminate the gap between patients' perception of knowledge and actual knowledge. The study indicates the need for patient counseling during hospitalization, with respect to medication therapy.

Characteristics of falls in hospitalized patients.

BACKGROUND: The high incidence of patient falls in a hospital setting is a major concern in any health system. Research findings have reported the risk factors for these falls as age, gender, certain medications, mental status, chronic diseases and environmental factors. Falls may lead to fear, pain, slight or severe injuries, increase the duration of hospital stay, cause patient discomfort and affect quality of life. AIM: The aim of this paper is to report a study of the characteristics of patient falls during hospitalization in 1998 and compare them with those in the period 1978-1981. METHODS: A retrospective study was performed in a large, 2000-bed medical center in Israel. Reports of 711 fall incidents in 1998 were compared with 328 reports in 1978-1981. Information gathered included age, gender, department, shift, reasons, severity of injury, tests and treatment after injury. RESULTS: The rates of falls per 1000 admissions in psychiatric, elder care and rehabilitation departments in 1998 were statistically significantly higher than in the earlier period. Rates of 115, 91, 85, respectively, per 1000 admissions were reported in 1998 compared with 34, 9, 19, respectively, in the period 1978-1981. The percentage of reported falls in the younger age group (under 50) was higher in the later survey (1998), and a higher proportion occurred outside the patient's room. Most of the reported falls in 1998 occurred during the morning shift (P < 0.001). CONCLUSIONS: The increased number of falls could be an outcome of increased awareness. Nevertheless, the causes and place of falls differ for the two periods. Some of the reasons may be related to an intervention programme carried out after the first survey. The latest survey results will serve as an important basis for a further intervention programme in specific departments to ensure patient safety.