Bridging the gap: A comparison of the professional nursing values of students, new graduates, and seasoned professionals.

Given the significant and widespread changes in the health care system, generational diversity and the resulting differences in values present a challenge for the nursing profession. A three-group comparative design was used to compare the professional nursing values held by nursing students, new graduates, and seasoned practitioners, utilizing the Nursing Professional Values Scale (Weis & Schank, 2000) developed from the American Nurses Association Code of Ethics. Findings revealed greater similarities than differences across the three groups; the notion that experience is necessary to develop professional values was not supported. Significant differences were seen across groups related to their knowledge regarding the code of ethics and its relevance to practice. Strategies to bridge the gap in value orientation between education and practice are offered as a means to strengthen professional commitment and maintain the viability of the profession.

Perceived nursing work environment of acute care pediatric nurses.

Nurse job satisfaction is a complex phenomenon and includes elements of the work environment. The purpose of this study was to evaluate nurses' perception of their real (current) and ideal (preferred) work environment in a pediatric tertiary care setting. Using a descriptive survey design, a convenience sample of staff nurses from three inpatient units was surveyed using the Work Environment Scale (WES) by Moos (1994). The WES consists of 10 subscales characterizing three dimensions: Relationship, Personal Growth, and System Maintenance and Change. Overall, nurses affirmed a highly positive and supportive work environment on their units. Non-significant findings between the real and ideal scores for the Involvement and Managerial Control subscales suggest that staff are concerned about and committed to their work, and satisfied with their managers' use of rules and procedures. Statistically significant differences between selected real and ideal subscale scores will help target intervention strategies to enhance the nursing work environment.

Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors.

INTRODUCTION: Overcrowding in emergency departments remains a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. Demographic and diagnostic characteristics were examined in an attempt to describe this national issue with more clarity. METHODS: The hospital decision support system was used to identify 2 readmission indicators (3-month return visits and 48-hour returns). Descriptive statistics and multiple regression techniques were used to analyze the characteristics of recidivists. Chart reviews and telephone interviews were conducted to further explore ED utilization. RESULTS: Twenty-five percent of the sample (N = 932) had at least one visit during the previous 3 months (N = 237). Four percent of the sample had a 48-hour return visit (N = 38). The findings revealed that the traditional determinants of ED utilization such as insurance and chronicity of symptoms are not reliable predictors of return visits. The risk factors of age, race, and diagnosis were significantly associated with return visit at a significance level less than .05. The findings confirm that some demographic and diagnostic predictability of return visits is indeed evident for pediatric patients. DISCUSSION: Although the sample is not representative, the data are helpful in identifying some of the issues of pediatric recidivism. Findings provide some understanding of parents' utilization of the emergency department and identified high-risk pediatric recidivists. Data also revealed specific disease entities warranting focused attention, such as nervous system diseases, sense organ diseases, digestive system diseases, infectious diseases, and parasitic diseases for children younger than 1 year. Patients with these problems may be at greater risk for return visits. ED nurses might consider nurse-initiated treatment protocols.

An observation unit in a pediatric emergency department: one children's hospital's experience.

INTRODUCTION: The observation unit at The Children's hospital in Denver is a care delivery system which provides expanded ED services to patients. The purposes of this study of the observation unit included: constructing a demographic profile; determining the distribution of admissions by diagnosis and related disposition; and evaluating staffing patterns and nursing workload. Issues related to safety, length of stay, and appropriate utilization were raised as well as the need to accurately identify the most effective nursing staff requirements to provide safe, quality care. METHODS: A sample of all patients admitted to the ED observation unit over a 6-month period (686 patients, 4.8% of ED patients) was studied. Descriptive statistics were used to describe the sample of patients. Nurse-to-patient staff ratios were calculated utilizing the BENCHmarking Effort to Network Children's Hospitals parameters. RESULTS: The average age of patients admitted to the observation unit was 4.36 years, equally distributed between males and females. Diagnostic categories were correlated to length of stay. Patients with respiratory illnesses required the longest observation. The majority of patients were discharged home after an average stay of 8.4 hours. DISCUSSION: Study findings inform clinical staffing and formulate guidelines for the ED observation unit usage.