Aaron Liberman

Nursing generations: an expanded look at the emergence of conflict and its resolution.

Never before have so many generations in nursing been asked to work together. The coexistence of 3 generations in nursing is leading to intergenerational conflict. The current intergenerational conflict is not enticing Generation X to seek or maintain nursing careers, therefore exacerbating the current nursing shortage. Using the theoretic frameworks of Conflict and Cohort theories, this article will examine and suggest the impact of generational diversity on the future of nursing.

Nursing leadership. Serving those who serve others.

Because of the current and projected continuance of an acute nursing shortage, increased attention is being focused on the workplace environment. This article encourages nursing leadership to examine the feasibility of implementing a servant-leadership model as a possible methodology for securing and retaining current and future nursing staff.

Stakeholder management in a hyperturbulent health care environment.

The fast-paced change in todays health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.

Emergency department utilization by insured users: a study of motivating factors.

Emergency departments (EDs) represent a critical entryway into Americas health care delivery system and are under significant pressure. This study seeks to understand why insured patients use EDs rather than more appropriate medical alternatives available to reduce the strain they are placing on this critical portal of entry. This exploratory research study surveyed insured patients presenting to 1 of 4 Central Florida EDs. Factor analysis and cluster analysis were used to identify groups of insured ED users defined by motivating factors. This study found that there exists a disconnect between insured individuals and the primary care system.

Not-for-profit versus for-profit health care providers--Part II: Comparing and contrasting their records.

The debate over which health care providers are most capably meeting their responsibilities in serving the publics interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part II of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of Americas public, it is also shown that both camps have been accused of being involved in potentially willful clinical and administrative missteps. Part I provided the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) required to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.

Health care reform and the pharmaceutical industry: crucial decisions are expected.

For the past 30 years, the largest growing segment of the United States economy is the health care industry. The United States is in a transitional period as American citizens born between 1946 and 1964, the Baby Boomer generation, reach retirement age. In recent years, pharmaceutical costs have been rising faster than the inflation rate, leaving the American public to ask many questions. A major area of interest to policymakers regarding the health care reform agenda is patient spending on pharmaceutical items. Government-funded programs such as Medicare and Medicaid are facing the possibility of running out of funds and require substantive reform. Pharmaceuticals are not covered under the basic Medicare programs. As a result, senior citizens are forced to cover their prescription expenses out of pocket or purchase supplemental insurance plans. This extra expense is leaving many senior citizens across the country struggling to support their ongoing medical needs.

An RBRVS approach to financial analysis in health care organizations.

Resource-based relative value scales (RBRVS) have altered the outpatient reimbursement system of Americas health care system and established a method of standardization whereby the efficiency of medical practices of varying size and complexity can be compared using a standard (the cost conversion factor) for analysis. This article compares the utility of RBRVS with earlier systems of reimbursement and concludes with a brief speculative assertion regarding the emergence of the next stage of ambulatory care reimbursements through ambulatory payment classifications.

Behavioral contract management: a prescription for employee and patient compliance.

A health care managers responsibilities of offering efficient service while ensuring effective outcomes is hampered frequently by both employees and patients whose unacceptable behaviors are detrimental to one or both of these mandates. Behavioral contracts offer a structured method that allows both patients and employees to self-actualize the required behavioral changes. When noncompliant behavior is diagnosed, behavioral contracts are the prescription that places the responsibility for corrective action squarely on the shoulders of the offending individual.

A supervised exercise program for dialysis patients: Effects of physical empowerment

Abstract Objective: The objective of this study was to determine the benefits, limitations, and physical capabilities resulting from a structured fitness program. Design: The perceptions of the 43 hemodialysis patients participating during the 5-month term of the study were subjected to statistical evaluation to determine any evidence of relationships between age, length of time in dialysis, and employment status versus ability to perform daily exercises, fitness level, fatigue, and energy level. Setting: The clinic from which the patients were selected includes three dialysis treatment facilities located in Pittsylvania, Halifax, and Henry Counties of Virginia. The clinical records of the 320 patients undergoing dialysis therapy at the time were evaluated based on selected medical criteria, and 256 patients were invited to participate in the program. Patients: A total of 43 patients participated in the exercycle component of the program whereas 33 elected to exercise independently through an approved YMCA or other community recreation program. Because of the anticipated difficulty in monitoring compliance of the patients exercising independently, only the 43 patients participating in the exercycle component were followed throughout the full course of the study. Among the 43 exercycle participants, 34 completed the full period of observation; 2 patients died for reasons unrelated to the exercise program; and 7 patients discontinued participation. Intervention: The program emphasized frequency, intensity, time, and type of exercise. The use of a stationary bike (exercycle) was selected as the method of evaluating patient progress resulting from the program. Main Outcome Measure: A questionnaire was administered pre-exercise and post-exercise program participation. Chi-squared analysis and percentages were used to assess the results of the study. Results: Although KtV and hematocrit levels showed a trend toward improvement, it was not possible to definitively conclude this occurred as a function of participation in the exercycle component of the exercise program; and no statistically significant relationships attributable as study outcomes were identified. Conclusion: Improvements in KtV and hematocrit levels suggested that a more extensive study with a substantially larger study group and a longer period of observation may yield more substantive and defining results. The small sample size of this study precluded definitive judgments.

Reimbursement challenges for emergency physicians.

Emergency physicians are under growing fiscal pressures on multiple fronts. Federal and state laws require that emergency care be provided to all those presenting at an emergency department, yet in nearly all cases there is no comparable mandate for reimbursement. The growing number of uninsured and underinsured, as well as downward pressure on reimbursement from managed care organizations and social assistance programs such as Medicaid and Medicare, also contributes to the difficulty of emergency physicians to be compensated. It may be time for the public to address more fundamental questions about the right to care and who pays for that care.