Betty Rambur

A statewide analysis of RNs' intention to leave their position.

Abstract The magnitude of the projected nursing shortage supports retention of Registered Nurses (RNs) as an essential healthcare workforce strategy. Purpose: This paper reports an analysis of RN workforce data in one rural state, Vermont; identifies patterns within this workforce; and details predictors of intention to leave current position for reasons of career advancement, life situations, or job dissatisfaction. Method: A secondary analysis of RN relicensure surveys was done, (n= 4418; response rate = 85%). Findings: Differences in intention to leave vary by educational attainment, hours worked per week, gender, practice role, and practice activity. Conclusion: Tackling nurse dissatisfaction in order to improve retention will require increased attention to compensation, education, and career development and flexibility, with resulting implications for state and federal policy formation.

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.

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.

Pregnancy Rhinitis and Rhinitis Medicamentosa

Purpose To present guidelines for the recognition, management, and referral of pregnancy rhinitis with a goal of improving the quality of the pregnancy experience for women afflicted with this condition. Data Sources A case study illustrating the presentation of a severe case of pregnancy rhinitis is followed a literature review of etiology, diagnosis, and management strategies. Conclusions Pregnancy rhinitis is a condition of clinical importance that is frequently exacerbated by use of intranasal decongestant sprays. The resulting rhinitis medicamentosa exacerbates the nasal obstruction, with resulting sleep disruptions that negatively impact the experience of pregnancy. Implications for Practice Nurse practitioners may miss opportunities to provide support, anticipatory guidance, and symptom relief. Anticipatory guidance that stresses the critical necessity of avoiding nasal spray decongestants, environmental modification, use of intranasal saline, moderate exercise, and nasal strips for subjective relief may have the potential to markedly decrease escalation of the condition to a serious disorder.

Advanced Practice Registered Nurse supply in a small state: trends to inform policy.

This study is a contribution to the small existing pool of state level research on Advanced Practice Registered Nurse (APRN) workforce supply. Data from four biennial surveys of Vermont APRNs from 2003, 2005, 2007, and 2009 (n = 1,538) were analyzed to produce descriptive statistics of one small state’s APRN demographic, educational, employment, job satisfaction, intention to leave, and practice-setting characteristics. Survey results were then used to identify patterns or trends that existed in the data. There was a marked shift in the employment settings and a decrease time worked as an APRN, despite an aging APRN workforce. There was an increase in the aggregate education level of APRNs; however, the percentage educated at the doctoral level remained flat at 2%. Overall, APRNs were a satisfied segment of the health workforce; however, those intending to leave for dissatisfaction voiced more concern about job stress and less concern about salary and benefits over time. Implications for workforce planning and public policy are discussed.

Metric-driven harm: An exploration of unintended consequences of performance measurement

Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smiths 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed.

Extra Young adults' perception of an ideal career: Does gender matter?

F or years, gender diversity in nursing has been recognized as being as important as racial and ethnic diversity in providing quality care for our population.1 Men, nevertheless, remain decidedly underrepresented in the nursing workforce. Despite the recession-related downturn in some healthcare markets, the magnitude of the projected nursing shortage—coupled with the complexity of the care provided by nurses—suggests that it’s valuable to recruit from the full potential talent pool to best serve our nation’s health needs. This study’s aim was to better understand similarities and differences by gender among young adults’ perception of an ideal career and their perception of nursing. This approach assumes that career choices, at least in part, are influenced by the perceived fit between a hypothetical ideal and potentially available career choices. The overall objective is to inform the development of evidencebased career recruitment strategies that are appropriately targeted to both men and women.

Reducing Preventable Hospitalizations With Two Models of Transitional Care

PURPOSE Transitional care is an emerging model of health care designed to decrease preventable adverse events and associated utilization of health care through temporary follow-up after hospital discharge. This study describes the approaches and outcomes of two distinct transitional care programs serving different populations: one is provided by masters-prepared clinical nurse specialists (CNS) with a chronic disease self-management focus, another by physicians specializing in palliative care (PPCs). Existing research has shown that transitional care programs with intensive follow-up reduce hospitalizations, emergency department (ED) visits, and costs. Few studies, however, have included side-by-side descriptions of the efficacy of transitional care programs varying by healthcare providers or program focus. DESIGN This is a retrospective cohort study comparing the number of ED visits and hospitalizations in the 120 days before and after the intervention for patients enrolled in each transitional care program. Each program included post-hospitalization home visits, but included differences in program focus (chronic disease vs. palliative), assessment and interventions, and population (rural vs. urban). Data from participants in the CNS program (September 2014 to December 2014) were analyzed (n = 98). The average age of participants was 69 years and 65% were female. Data were collected from patients from the PPC program from September 2014 to April 2015 (n = 71). Thirty participants died within 120 days after the intervention and were excluded; the remaining 41 were included in the analysis. Participants had an average age of 81 years and 63% were female. METHODS For the CNS program, a secondary analysis of existing data was performed. For the PPC program, a review of patient charts was done to collect data on encounters. A Wilcoxon matched-pairs signed-rank test was performed to test for significance. FINDINGS Patients in the CNS intervention had significantly fewer ED visits (p < .005) and hospitalizations (p < .005) in the 4 months after the intervention than in the 4 months before the intervention. Patients in the PPC program had a nonsignificant reduction in ED visits (p = .327) and a significant reduction in hospitalizations postintervention (p = .03). CONCLUSIONS Both transitional programs have value in decreasing rehospitalizations. The CNS intervention also significantly reduced ED visits for their target population. Further study with randomized controlled trials is needed to allow for a better understanding of the healthcare workforce best fitted to enhance transitional care outcomes. Future study to examine the cost savings of each of the interventions is also needed. CLINICAL RELEVANCE Transitional care programs have the potential to prevent unnecessary utilization of health care at the critical periods of transition that leave patients vulnerable to adverse events and poor outcomes.

Education and Employment Characteristics of Nurse Preceptors

BACKGROUND Nurse preceptors are vital linchpins, supporting the transition of new graduates to practicing registered nurses (RNs). This research clarifies similarities and differences among preceptors and nonpreceptors in an established statewide preceptor program. METHODS A secondary analysis of relicensure data from all nurses working in Vermont hospitals in two years (2005 and 2009) was undertaken. RESULTS There were no statistical differences by basic degree type, highest degree, RN experience, years in the current job, job satisfaction, and intention to leave. Statistically significant differences that persisted over time included: (1) being less likely to be employed per diem; (2) work site population density; and (3) being more likely to be enrolled in nursing education programs. CONCLUSION Given the lack of obvious identifiers, organizations would benefit from a systemized approach to preceptor identification and development. Regulators, who hold the clear social and legal mandate for patient safety, must also be an enabling force toward change.

An Aging Nursing Workforce Necessitates Change

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