Jack M. Geller

The New Environmental Paradigm Scale: A Reexamination

Abstract To examine and measure the paradigmatic shifts in the publics orientation toward the physical environment, Dunlap and Van Liere developed the New Environmental Paradigm Scale. This study examines the dimensionality of the NEP scale. The scale was tested in three different settings to assess its stability. Using confirmatory factor analysis we were unable to confirm any of the previous configurations of the scales dimensionality. We were, however, able to confirm the dimensionality of a three-factor model using nine of the items from the original scale. Further, the extracted factor pattern for our model closely resembles the findings reported by Albrecht et al.

Effects of an Expanded Medical Curriculum on the Number of Graduates Practicing in a Rural State.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSMs Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976–1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state “natives”) from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable “retaining” effect on the UNDSM alumni.

Retainment Incentives in Three Rural Practice Settings: Variations in Job Satisfaction Among Staff Registered Nurses

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

The effects of clinical decision making on nurse practitioners' clinical productivity.

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs’ levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.

Restrictive practice environment and nurse practitioners' prescriptive authority.

&NA; This study analyzes the impacts of several variables, including a restrictive practice environment, on a nurse practitioners level of autonomy with respect to prescribing selected categories of medicines. A general linear model is applied to data from the 1992 national sample of nurse practitioners. Results show that among the significant independent variables, a restrictive environment of imposed state laws and regulations reduces nurse practitioners’ level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. Results and policy implications are discussed.

Recruiting and retaining registered nurses in rural community hospitals. Some administrative assessments.

The costs and impacts associated with the recruitment and retention of nurses are substantial. In rural areas, these efforts are hampered by the recurring maldistribution of available nurses away from such environments. Based on a survey of 195 directors of nursing (DONs) practicing in rural community hospitals, the authors compare administrative assessments of recruitment and retention efforts of DONs practicing in various-sized rural facilities. Current full-time equivalent registered nurse staff vacancy rates are also reported in relation to these differing assessments.

Recruiting registered nurses to rural practice settings: an assessment of strategies and barriers.

It has been suggested that in rural settings, the primary difficulty that faces nursing administrators is recruitment of registered nurses (RNs). This study examines the impact of recruitment strategies and barriers by comparing and contrasting corresponding RN full-time equivalent (FTE) vacancy rates. Data were gathered from a multistate telephone survey of directors of nursing (DONs) practicing in rural hospitals, skilled nursing facilities (SNFs), and public health settings (N = 556, response rate = 89.5%). The investigators found that DONs who perceived scheduling amenities and autonomy enhancements corresponded with RN FTE vacancy rates that were most reduced from the mean of the overall sample. Regarding recruitment barriers, geographic locale/isolation and job-related factors corresponded with RN FTE vacancy rates that were most elevated from the overall sample mean.