Tai Chi for older nurses: a workplace wellness pilot study.

PURPOSE: The purpose of this pilot study was to assess the feasibility of a Tai Chi workplace wellness program as a cost effective way of improving physical and mental health, reducing work related stress, and improving work productivity among older nurses in a hospital setting Design A randomized control trial of two groups (control and Tai Chi group). DESIGN: A randomized control trial of two groups (control and Tai Chi group). SETTINGS: Northeastern academic medical center. SUBJECTS: A convenience sample of eleven female nurses (mean age 54.4 years). INTERVENTION: The Tai Chi group (n = 6) was asked to attend Tai Chi classes once a week offered at their worksite and to practice on their own for 10 minutes each day at least 4 days per week for 15 weeks. Controls (n = 5) received no intervention. MEASURES: SF-36 Health Survey, Nursing Stress Scale (NSS), Perceived Stress Scale (PSS), Sit-and-Reach test, Functional Reach test, the Work Limitations Questionnaire, workplace injury and unscheduled time off. ANALYSIS: The two study groups were compared descriptively and changes across time in the intervention versus control were compared. RESULTS: The Tai Chi group took no unscheduled time-off hours, whereas, the control group was absent 49 hours during the study period. There was also a 3% increase in work productivity and significant improvement in functional reach (p=0.03) compared to the control group. Other outcomes were not statistically significant. CONCLUSION: This pilot study demonstrates the feasibility of Tai Chi with older female workers as a cost effective wellness option in the workplace; thus encouraging replication with a larger sample. Methodological implications were also addressed.

Practical nurses' health and safety in nursing homes.

PURPOSE: Practical nurses (PNs) rated their general and emotional health and their employers' attention to their health and safety. These components were examined in relationship to work setting and intention to leave for the purpose of exploring workforce issues involving these important care providers of frail elders. DESIGN/METHODS: A relicensure survey mailed to all PNs in one rural state included the Minimum Data Set for nurse workforce supply plus questions from the Health and Retirement Survey. Data were analyzed using Kruskal-Wallis nonparametric ANOVA, t-test, and chi-square tests. RESULTS: Of the state's working PNs, 813 responded, (71%) and 34% (n=269) reported nursing home employment. Overall, age and work role were not significantly associated with self-rated general health (p=0.14 and p=0.12). Males reported poorer general (p=0.09) and emotional (p=0.004) health. PNs working in nursing homes rated their general and emotional health lower than PNs in other settings (p<0.001). Of the PNs in nursing homes, 28% reported they were likely to leave their position within one year, versus 19% in other work settings (p=0.003). PNs with higher evaluations of their employer safety practices were less likely to leave. IMPLICATIONS: Understanding PNs perceived general/emotional health and perceptions of workplace health/safety efforts can inform interventions to reduce turnover.

An aging nursing workforce necessitates change.

Use the Older Worker Lure Scale to rate your organization's ability to attract and retain older nurses.

Knowledge and perceptions of quality systems among Vermont laboratorians.

OBJECTIVES: This article reports on a survey of medical laboratorians' knowledge of quality systems in their workplace and their perceptions about the effect of job function, education and training, professional credentials, and experience on the overall quality of testing and results. METHODS: The Medical Laboratory Workforce Survey was designed and conducted in Vermont in 2005. Surveys were distributed to all laboratorians working in Clinical Laboratory Improvement Amendments-regulated laboratories throughout Vermont. Results were analyzed for statistical significance using the Fisher's exact test for overall group comparisons. RESULTS: Laboratorians perceived that they were generally knowledgeable about the quality systems in place in their laboratories (96% considered themselves familiar with quality assurance [OA] measures in their laboratory), but meeting quality objectives and perceptions of factors that impact quality measures in the laboratory were variably influenced by the laboratorians' years of experience, professional credentials, organization type, and job title. Almost half (47%) of laboratorians said they did not have a role in deciding the QA measures, whereas 77% felt they had a significant impact on meeting the QA objectives. CONCLUSIONS: Not all laboratorians feel that they play a significant role in assuring quality or influencing quality measures used in the laboratory. All laboratorians should be encouraged to take an active approach to influence quality systems in the laboratory to ensure the highest quality health care possible.

Registered nurses' perceptions of health and safety related to their intention to leave.

This study examined perceptions of general and emotional health among a statewide sample of nurses, and their assessment of employers' workplace health and safety initiatives. These variables and demographic data were then used to model predictors of intention to leave their work positions. A survey was mailed to all registered nurses in one state. Fifty-three percent responded (n = 3,955). Findings suggested marked differences in perception of emotional health by age, with younger nurses reporting less positive perceptions of their emotional health. Perceptions of employers' safety and health initiatives varied by age, setting, and work role. Predictors of intention to leave included lower perceived emotional health among younger nurses and employer safety initiatives for both age groups. This exploratory study suggests a relationship among employer health and safety practices, nurses' emotional health, and intention to leave. Implications for occupational health nurses are detailed.

Retaining an aging nurse workforce: perceptions of human resource practices.

The expected retirement of the largest cohort of nurses will push the RN workforce below projected need by 2020. The challenges of managing a nursing workforce with the majority of nurses over 45 years of age are now necessitating attention to polices for recruitment and retention of older nurses, particularly in rural areas. This convenience sample study employed a mailed survey to investigate perceptions of nurses in 12 institutions (four hospitals, seven home health agencies, and one nursing home serving a small rural state). The goal was to explore rural RNs' perceptions of intent to stay in their current position, with their organization, and employment as a nurse; organizational and unit-level culture regarding older nurses in the workplace; importance of specific human resource practices/policies to their own intention to stay; and extent to which these human resource practices/policies are currently done. The results indicate that although there are similarities across age cohorts, important differences exist that can be addressed to create career-span sensitive policies and practices. This study provides an indicator of progress or lack of progress in addressing older nurse recruitment and retention, and also offers guidance for differentiating policies and practices for younger and older nurses.

Reported goal setting and benefits of person centred planning for people with intellectual disabilities.

Recent research suggests that person centred planning (PCP) can have a positive impact on the lives of people with intellectual disabilities. This article presents data from open-ended comments collected during research on the impact of PCP on the life experiences of 65 people with intellectual disabilities living in England. These comments addressed the goals set prior to and during PCP, and the main benefits of PCP for participants. The results suggest that PCP led to increased goal setting in a range of goal categories. This was reflected in the most common main benefit of PCP of ;increased activities and opportunities' reported for 57 percent of participants. For 48 percent of participants, a main benefit of PCP was that they felt better in themselves, in terms of happiness or self-esteem. This must surely be the ultimate aim of those seeking to improve the quality of life of people with intellectual disabilities.

Perceptions of an ideal career versus perceptions of six health careers.

OBJECTIVE: This study was intended to compare and contrast young adults' perceptions of an ideal career versus their perceptions of six health professions: medical laboratory science, nursing, pharmacy, physical therapy, radiation technology, and respiratory therapy. STUDY DESIGN: The study used a survey developed by May et al., which was modified and tested for application to the allied health workforce. The instrument measures 17 parallel items on a five-point Likert scale and has been assessed for reliability (coefficient a, 0.81-0.84) and content validity by a panel of experts. Analysis included descriptive statistics and paired t tests, with Bonferroni adjusted a significance set at p < 0.0028. POPULATION: The study used a convenience sample of 720 young adults aged 18 to 24 yrs who were recruited between January and September 2005 at job fairs and community events in one urban area and two adjacent rural communities in a northeastern U.S. state. FINDINGS: All six health professions were perceived as significantly less desirable (p < 0.001) than the ideal career in the areas of "being respected" and "working with high technology." "Care for people" was the third highest ranked attribute of an ideal career, and pharmacy and radiation technology were found to be statistically significantly lower in this area (p < 0.001). Only nurses were perceived as having job security that matched the ideal, with the other professions perceived as offering significantly less job security than the ideal (p < 0.001). CONCLUSIONS: Health care is increasingly dependent on highly collaborative multidisciplinary teams. Inaccurate perceptions of allied health occupations likely hamper the development of an adequate pipeline of new recruits to these professions, which has the potential to impact all health disciplines. This points to the importance of increased media/marketing portrayal of the positive aspects of careers in the allied health professions. Strategies to address this challenge and areas for further research are outlined.

Patient decision-making related to antirheumatic drugs in rheumatoid arthritis: the importance of patient trust of physician.

OBJECTIVE: To explore how rheumatoid arthritis (RA) antirheumatic drug-specific knowledge and numeric literacy, patient trust in physician, and demographic and disease-related factors relate to the confidence of patient decision-making related to disease modifying antirheumatic drugs (DMARD). METHODS: Data were analyzed from 628 randomly selected patients with RA receiving care in community rheumatology practices, who responded to a multicenter, cross-sectional mail survey. We used multiple regression models to predict patient confidence in DMARD decision-making related to their most recently initiated DMARD. RESULTS: Significant positive correlation was found between confidence in DMARD decision and trust in physician, DMARD-specific knowledge, and disease duration, but not risk-related numeric literacy, sex, or education. Negative correlations were found with disease severity and current bother with DMARD side effects. A multiple linear regression model of confidence in DMARD decision had an overall R = 0.788, R2 = 0.620 (p < 0.001). The 4 dependent variables contributing significantly to the model were female sex, Medicaid insurance status, satisfaction with RA disease control, and trust in physician, with standardized beta = 0.077, -0.089, 0.147, and 0.687, respectively. CONCLUSION: In this sample of community patients with RA, the patient trust in physician had substantially greater effect on confidence in DMARD decision than DMARD-specific knowledge, disease-related factors, or demographic characteristics.

Does a 'shadow workforce' of inactive nurses exist?

The entire population of inactive nurses in Vermont was surveyed to determine if a "shadow workforce" exists. The notion that large numbers of nurses are available to return to work is not supported by this study. Desirable benefits for those wishing to return are discussed.

Longitudinal analysis of the impact and cost of person-centered planning for people with intellectual disabilities in England.

Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual disabilities over 2 years across four localities in England. A person-centered plan was successfully developed for 65 people. Little change was apparent prior to introducing person-centered planning. After its introduction, modest positive changes were found in the areas of social networks; contact with family; contact with friends; community-based activities; scheduled day activities; and choice. The direct training and support cost of introducing person-centered planning was $1,202 per participant; indirect costs were negligible.

Measuring the nursing workforce: clarifying the definitions.

Numerous articles have addressed the causes and implications of the current nursing shortage. Little has been published, however, about how to measure the nursing workforce. This article presents (1) a review of definitions for common workforce indicators such as vacancy and turnoverrates and the relationship between these indicators and the need for nurses,(2) a review of the calculation of vacancy and turnoverrates in several statewide and national surveys, and (3) the results from the development and pilot test of a health care workforce survey for use in Vermont. The review indicates that in practice, no standard method is used despite attempts to standardize the calculation of vacancy and turnover rates. The Vermont pilot study results demonstrate that a richer profile of the health workforce can be obtained by using both standard workforce measures and more subjective questions to assess a statewide need for nurses.

The volunteer potential of inactive nurses for disaster preparedness.

OBJECTIVES: Inactive nurses' interest in volunteering for emergency preparedness was examined. METHODS: A mail survey was sent to the entire Vermont Board of Nursing list of in-state inactive and lapsed registered nurses (n = 3,682). A high rate of undeliverable surveys (60%) was found and 611 surveys were returned for a 20% response rate. RESULTS: Twenty-seven percent of the respondents were interested in volunteering. Those interested in participating in volunteer work as part of a national homeland security effort were significantly more likely to (a) be younger in age (p < 0.0001); (b) identify themselves as "being a nurse" (p = 0.001); (c) be employed versus retired (p = 0.002); and (d) be currently volunteers (p = 0.001). CONCLUSIONS: Because 33% of the nation's nurses are over age 50, inactive nurses offer a potentially large pool of volunteers for emergency preparedness training and response in the years to come.

Education as a determinant of career retention and job satisfaction among registered nurses.

PURPOSE: To compare job satisfaction and career retention in two cohorts of RNs, those whose highest degrees were the associate degree (AD) or the bachelor's degree (BS) in nursing. DESIGN: Survey. METHODS: Instruments included a career satisfaction scale and questions based on the ongoing U.S. Health and Retirement Survey. Three-thousand nurses in the U.S. state of Vermont were surveyed with a resulting response rate of 56.7%. Of these respondents, 878 RNs fit the study criteria. FINDINGS: BS RNs started their nursing careers earlier, were employed longer, had held more positions, and in the largest age cohort (age 40-54), were more likely to have been in their current positions at least 10 years. BS RNs scored significantly higher in job satisfaction related to: (a) opportunity for autonomy and growth, (b) job stress and physical demands, and (c) job and organizational security. AD and BS nurses were not significantly different in their satisfaction with supervision; career, continuing education, and promotion opportunities; or pay and benefits. CONCLUSIONS: These findings indicate support of bachelor's level education for individual and social return on investment, and they show that AD education might have unintended consequences. Implications for the nursing shortage and educational policy are discussed.

Changes in rates of beta-blocker use in community hospital patients with acute myocardial infarction.

OBJECTIVE: To examine changes in the rate of beta-blocker (BB) use at admission, in hospital, and at discharge between 1994 and 1995 (MICH I) and 1997 (MICH II) in patients with acute myocardial infarction (AMI). DESIGN: Comparison of two prospectively enrolled cohorts. SETTING: Five mid-Michigan community hospitals. PATIENTS: We studied 287 MICH I patients and 121 MICH II patients with AMI who had no contraindications to BB use from cohorts of consecutively admitted cases of AMI (814 in MICH I; 500 in MICH II). RESULTS: Prescription of BBs to ideal patients with AMI increased in patients with previous history of myocardial infarction on arrival at the hospital (12.5% vs 36.0%; P= .01), in hospital (47.0% vs 76%; P < .01), and at discharge (34.0% vs 61.9%; P < .01). Neither race nor gender was a predictor of BB use. Younger age predicted BB prescription at discharge (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.32 to 3.23). Later study cohort was the most important predictor of BB use in hospital (OR, 3.4; 95% CI, 2.09 to 5.25). CONCLUSION: BB use improved dramatically over the study period, but additional work is needed to improve use of BB after discharge and among elderly patients with AMI.