George A. Zangaro

Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008

BACKGROUND Advanced practice nurses (APNs) in the United States could expand access to high-quality health care, particularly for underserved populations. Yet, there has been limited synthesis of the evidence related to their effectiveness as compared with other providers. The study reported here, part of a larger study that examined all four types of APNs, compares the labor and delivery care outcomes of certified nurse-midwives (CNMs) and physicians. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Proquest (for dissertations), were searched for the years 1990 through 2008. STUDY ELIGIBILITY CRITERIA Only those articles where processes or outcomes of care were quantitatively compared between CNMs and physicians were included. For all APNs, 27,993 citations were reviewed. For CNMs, 21 articles representing 18 unique studies reported either infant or maternal outcomes. METHODS The systematic review followed established procedures (replicable search of relevant databases, sequential review to identify eligible studies, abstraction by two reviewers, assessment of quality, and grading of evidence). RESULTS For measures that relate to the processes of care (e.g., epidural, labor induction, episiotomy), lower use was found for CNMs. For many of the infant outcomes (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding was higher among women cared for by CNMs compared with physicians. LIMITATIONS The review addressed only CNMs practicing in the United States and outcomes measured during labor and delivery. The majority of study designs were observational and the models of care ranged from independent to shared, limiting the control for bias. Moreover, all reviewers were nurses. CONCLUSION Differences in practice between CNMs and MDs seem to be well documented, particularly in the use of technology. Yet, the findings provide evidence that care by CNMs is safe and effective. CNMs should be better utilized to address the projected health care workforce shortages.

Meta-analysis of the reliability and validity of Part B of the Index of Work Satisfaction across studies.

Nurses’ job satisfaction is a crucial factor in health care organizations. This study uses meta-analysis for reliability generalization and synthesis of construct validity of Part B of the Index of Work Satisfaction (IWS), a measure of job satisfaction. Meta-analysis was performed including assessments of study quality and descriptive coding of studies. Rater reliability was assessed for all coding and extraction of data. The mean reliability of Part B scores of the IWS based on 14 studies was .78 (df = 13, p < .05). The mean score reliability was .77 for university settings, .73 for community/acute care hospitals, .77 for multi-site studies, and .90 for other settings. For studies rated high and low quality, the mean score reliability was .77 and .83, respectively. Scores on Part B of the IWS correlated −.38 with turnover intent, .60 with organizational commitment, and −.53 with job stress. Scores on Part B of the IWS are reliable for measuring job satisfaction of nurses across samples. Construct validity needs additional testing.

Registered Nurses’ Job Satisfaction in Navy Hospitals

Because of the increasing use of civilian registered nurses to supplement the nursing staff at U.S. Navy hospitals, it is imperative to understand the factors that influence satisfaction in both Navy and civilian nurses in military hospitals. This study sought to expand knowledge of satisfaction in hospital-based active duty Navy registered nurses and federal civilian nurses. Respondents completed a survey with a response rate of 42% (N=496). The survey was designed using well-known satisfaction models and included measures of work attitudes, work setting, and demographic characteristics. Linear regression models explained 51% of the variance in job satisfaction for Navy nurses and 55% for civilian nurses. Routinization had the strongest significant negative association with job satisfaction for Navy and civilian nurses. Supervisor support was significantly associated with satisfaction for Navy nurses although coworker support was a significant factor for civilians. These findings have implications for nurse administrators and health care executives who desire to retain nurse employees.

Policy Implications for Optimizing Advanced Practice Registered Nurse Use Nationally

This article examines the potential benefits of enhanced use of advanced practice registered nurses (APRNs) given health care workforce projections that predict an inadequate supply of certain types of providers. The conclusions of a systematic review comparing the effectiveness of care provided by APRNs with that of physicians alone or teams without APRNs indicate the viability of this approach. Allowing APRNs to assume roles that take full advantage of their educational preparation could mitigate the shortage of primary care physicians and improve care processes. The development of health care policy should be guided by patient-centric evidence rather than how care has been delivered in the past.

Meta‐analysis of the reliability and validity of the Anticipated Turnover Scale across studies of registered nurses in the United States

BACKGROUND Globally, there are serious human and financial costs associated with registered nurse (RN) turnover. Anticipating turnover before turnover occurs is important to prevent costly and unnecessary turnover. Using a reliable and valid measure of anticipated turnover is essential to credible healthcare research on which nursing policy decisions are based. This meta-analysis provides a systematic way to determine the legitimacy of the use of the Anticipated Turnover Scale (ATS) in RN workforce research. AIMS The aims of this meta-analysis were to determine the consistency of reliability estimates and evidence of construct validity of ATS scores across studies of RNs in the US. A secondary purpose was to evaluate variability in reliability and validity according to study quality, century within which studies were conducted and whether studies were published or unpublished. METHODS Search strategies included accessing computerized databases, emailing researchers, consulting experts, footnote-chasing and accessing unpublished reports. Two independent reviewers examined studies according to inclusion criteria and quality. Consensus was reached on selected studies and quality ratings. RESULTS Overall mean weighted effect size (MWES) of reliability from 12 studies was 0.89. Overall MWES of validity correlating the ATS and four job satisfaction measures for seven studies was -0.53. There was variability in reliability according to quality of studies. CONCLUSION The ATS demonstrated excellent reliability and construct validity across studies of RNs in the US. IMPLICATIONS FOR NURSING MANAGEMENT   Nursing management should consider the ATS in research on prevention of RN turnover.

Job satisfaction and retention of military nurses: a review of the literature.

Job satisfaction is an extremely important concept that influences a nurses decision to stay in an organization, as well as the cost of turnover and the nursing shortage. The purpose of this review is to identify published research studies that have assessed job satisfaction and retention (intent to stay) in military nurses serving in the Army, Navy, or Air Force. The available literature was searched from 1980 to 2010 and the review resulted in 21 studies. The majority of the studies used a descriptive correlational design and was specific to one particular service. The researchers reported several satisfiers such as strong sense of teamwork, favorable work environments, pay and benefits, promotional opportunities, leadership and management experiences offered to junior officers. One of the major dissatisfiers was the lack of support from leadership. Nurse researchers must expand the retention science with robust longitudinal interventional studies. Nurse researchers are well positioned to provide military nurse leaders with the best possible evidence to address issues and make decisions regarding nurse retention.

The Health Resources and Services Administration diversity data collection.

The Health Resources and Services Administration maintains a strong emphasis on increasing the diversity of the health-care workforce through its grant programs. Increasing the diversity of the workforce is important for reducing health disparities in the population caused by socioeconomic, geographic, and race/ethnicity factors because evidence suggests that minority health professionals are more likely to serve in areas with a high proportion of underrepresented racial and ethnic minority groups. The data show success in increasing the diversity of enrollees in five nursing programs.

Students' experiences with military nurses as faculty.

The United States Army Nurse Corps (ANC) and the University of Maryland School of Nursing (UMDSON) formed a partnership to address the nursing faculty shortage. Six ANC officers served as full-time faculty at the UMDSON for a 2-year period. Given that the student experience is central to the context of learning, the purpose of this study was to describe the experience of the students who interacted with ANC officers. Using a descriptive phenomenological approach, 14 nursing students participated in open-ended, in-depth, audiotaped interviews. Although the students had preconceived ideas about ANC officers as faculty, following engagement with the officers, the students reported many positive attributes of having ANC officers as clinical instructors and an enlightened understanding of the role of the military in todays world. The findings of this study indicate that the use of ANC officers is a plausible solution to the ongoing nursing shortage.

Diversifying the Health-Care Workforce Begins at the Pipeline: A 5-Year Synthesis of Processes and Outputs of the Scholarships for Disadvantaged Students Program.

The case for a more diverse health-care workforce has never been stronger given the rapidly changing demographics of the United States and the continued underrepresentation of certain racial and ethnic groups across the health professions. To date, progress toward diversifying the health-care workforce has been and continues to be deterred by a mix of factors at the societal, institutional, and individual levels. Since the 1970s, the Federal government has invested resources in initiatives that support the training and development of the existing workforce as well increase the supply of new health professionals—particularly those from underrepresented minority groups and/or from disadvantaged backgrounds. However, limited studies have been published detailing the processes, outputs and, where available, outcomes of such investments across multiple years. This article describes how the Health Resources and Services Administration’s Bureau of Health Workforce used retrospective case study methodology to evaluate processes and outputs associated with the Scholarships for Disadvantaged Students program—an over US

Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review

40 million annual Federal investment aimed at offsetting tuition costs for health professions students from disadvantaged backgrounds—over a 5-year period. Lessons learned and recommendations for strengthening the program’s design and requirements are provided.