J. Margo Brooks Carthon

The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals

Introduction Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. Aim The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. Methods Cross-sectional examination, using three linked data sources—(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data— from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. Results The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2–8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). Conclusions Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes.

Medicare Readmissions Policies and Racial and Ethnic Health Disparities: A Cautionary Tale

Beginning in 2009, the Centers for Medicare & Medicaid Services started publicly reporting hospital readmission rates as part of the Hospital Compare website. Hospitals will begin having payments reduced if their readmission rates are higher than expected starting in fiscal year 2013. Value-based purchasing initiatives including public reporting and pay-for-performance incentives have the potential to increase quality of care. There is concern, however, that hospitals providing service to minority communities may be disproportionately penalized as a result of these policies due to higher rates of readmissions among racial and ethnic minority groups. Using 2008 Medicare data, we assess the risk for readmission for minorities and discuss implications for minority-serving institutions.

Variations in postoperative complications according to race, ethnicity, and sex in older adults.

To explore differences in the incidence of postoperative complications between three racial and ethnic groups (white, black, Hispanic) before and after taking into account potentially confounding patient and hospital characteristics.

The Untapped Potential of the Nurse Practitioner Workforce in Reducing Health Disparities

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs’ potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs’ contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health.

“They’re on the Fast Track”: Older Blacks Describe Experiences of Nursing Care Quality During Hospitalization:

Older Black patients are at increased risk for experiencing a hospital readmission. This disparity may be related to a variety of factors, including care received during hospitalization. The purpose of this study was to elicit the perceptions of older Black patients at high risk for readmission, and explore their nursing care needs and preferences during and following hospitalization. A qualitative descriptive design was used, including individual interviews with 19 Black members of a Program of All-Inclusive Care for the Elderly facility located in a northeastern urban setting. Four themes were captured encompassing characteristics of nursing care quality, unmet care needs, nurse–patient communication, and observations of competing nursing demands. Efforts to improve care transitions and prevent readmissions must address the needs and preferences of high-risk older Black patients while also attending to system-level inefficiencies that decrease the ability for nurses to complete all aspects of care.

Effective Strategies for Achieving Scope of Practice Reform in Pennsylvania

Background Current regulatory impediments prohibit advanced practice registered nurses from practicing to their full capacity. Purpose To examine the process of successful removal of scope of practice barriers in Pennsylvania under the Rx4PA legislation introduced in 2007. Method We used qualitative research techniques, including purposeful sampling of participants. Twelve stakeholder informed interviews were conducted between October 2013 and May 2014. Participants were closely involved with the development of the Rx4PA legislation. Thematic content analysis was performed to analyze our interviews. Discussion Interviews identified overarching themes, including the importance of leveraging years of grass roots advocacy, identifying political allies, and recognizing mutually beneficial compromises. Conclusions The combination of timing, careful political maneuvering, and compromise were key to scope of practice reform in Pennsylvania and may be useful strategies for other states seeking similar practice changes.

Enrollment of underrepresented minorities in nursing majors: A cross sectional analysis of U.S. nursing schools

PURPOSE To investigate if underrepresented racial and ethnic minorities have distinct enrollment patterns when different diversity programmatic services are in place. DESIGN Secondary analysis of linked data from an electronic survey conducted (2012-2013) and AACN baccalaureate enrollment data across 25 schools of nursing in 15 states. Logistic regression was used to determine the likelihood of minority student enrollment in nursing programs when 14 distinct programmatic support services were in operation. FINDINGS Asian students were most likely to enroll in nursing programs with career services in place (O.R. 2.2, p=0.01). Black/African American student enrollment was associated with financial support (O.R., 1.52, p=<.001), mentoring (O.R.=2.49, p=<.001), community partnerships (O.R. 1.97, p=<.001), diversity workshops (O.R.=1.95, p=<.001) and clinical experiences (OR=2.25, p=<.001), academic (O.R.=2.58, p=<.001), and psychosocial (OR 1.74, p=<.001) services. Hispanic student enrollment was associated with academic support (O.R. 2.97, p=<.001), mentoring (O.R. 1.38, p=<.001), diversity workshops (O.R. 1.22, p=<.001), and community service (O.R. 1.66, p=<.001). Non-Hispanic White students were more apt to be enrolled in nursing schools offering financial support (O.R., 1.27, p=<.001), internships/externships (O.R.=1.5, p=<.001), research opportunities (O.R. 2.01, p=<.001), clinical experiences (O.R.=1.71, p=<.001), diversity workshops (O.R. 1.2, p=<.001). CONCLUSIONS Differences in enrollment patterns among minority students may be attributed to efficacy of individual structured support services. These differences suggest the importance of tailoring diversity support services to meet the unique needs of students from diverse backgrounds.

Increasing Research Capacity in a Safety Net Setting Through an Academic Clinical Partnership

Safety net settings care for a disproportionate share of low-resource patients often have fewer resources to invest in nursing research. To address this dilemma, an academic-clinical partnership was formed in an effort to increase nursing research capacity at a safety net setting. Penn Presbyterian Medical Center and the Center for Health Outcomes and Policy Research located at the University of Pennsylvania partnered researchers and baccalaureate-prepared nurses in an 18-month research skill development program. This article describes the programmatic design, conceptual framework, resource requirements, and effect on the institutional partners and participants.