Jacqueline A. Choiniere

Nursing Home Staffing Standards and Staffing Levels in Six Countries

PURPOSE This study was designed to collect and compare nurse staffing standards and staffing levels in six counties: the United States, Canada, England, Germany, Norway, and Sweden. DESIGN The study used descriptive information on staffing regulations and policies as well as actual staffing levels for registered nurses, licensed nurses, and nursing assistants across states, provinces, regions, and countries. METHODS Data were collected from Internet searches of staffing regulations and policies along with statistical data on actual staffing from reports and documents. Staffing data were converted to hours per resident day to facilitate comparisons across countries. FINDINGS We found wide variations in both nurse staffing standards and actual staffing levels within and across countries, although comparisons were difficult to make due to differences in measuring staffing, the vagueness of standards, and limited availability of actual staffing data. Both the standards and levels in most countries (except Norway and Sweden) were lower than the recommended levels by experts. CONCLUSIONS Our findings demonstrate the need for further attention to nurse staffing standards and levels in order to assure the quality of nursing home care. CLINICAL RELEVANCE A high quality of nursing home care requires adequate levels of nurse staffing, and nurse staffing standards have been shown to improve staffing levels.

Everyday experiences of implicit rationing : comparing the voices of nurses in California and British Columbia

Managed Care in the U.S. is one of the more controversial strategies to implicitly ration health care. It has also been creeping into Canada where care is similarly being managed albeit in a different socio-political environment, Based on nine group interviews with 35 RNs in California and 10 group interviews with 39 RNs in British Columbia, we find that the price to be paid for the promise of cheaper, more efficient health care through managerial strategies is borne largely by nurses and other health care providers. The data reveal that nurses in British Columbia and California share similar experiences with how the amount of care is rationed at the bedside - through care pathways, early discharge policies and reduced staffing - while the rationing of access to care differs because of the socio-political contexts of their respective health care systems. In both cases, the implicit rationing of care through managerial strategies fails to deliver on its promises.

Conceptualizing structural violence in the context of mental health nursing.

This article explores how the intersections of gendered, racialized and neoliberal dynamics reproduce social inequality and shape the violence that nurses face. Grounded in the interviews and focus groups conducted with a purposeful sample of 17 registered nurses (RNs) and registered practical nurses (RPNs) currently working in Ontarios mental health sector, our analysis underscores the need to move beyond reductionist notions of violence as simply individual physical or psychological events. While acknowledging that violence is a very real and disturbing experience for individual nurses, our article casts light on the importance of a broader, power structure analysis of violence experienced by nurses in this sector, arguing that effective redress lies beyond blame shifting between clients/patients and nurses. Our analysis illustrates how assumptions about gender, race and care operate in the context of global, neoliberal forces to reinforce, intensify and create, as well as obscure, structural violence through mechanisms of individualization and normalization.

Walking the talk: insights into dynamics of race and gender for nurses.

This article explores how the dynamics of violence and support for nurses are influenced by the intersections of race, gender, and other social relations in various practice settings. Utilizing a qualitative study design, situated in the naturalistic and critical paradigms, this article is grounded in the experiences of key informants (KIs), each possessing significant expertise on issues of equity and violence, as well as insight into the current practice settings in Ontario, Canada. The individual KI interviews were analyzed using conventional qualitative content analysis, with its focus on capturing emerging insights. The findings reflect the everyday nature of gendered and racialized violence, the influence of setting and the effectiveness of existing resources. Professional, organizational, and broader policy implications are discussed to support diversely situated nurses within their various practice environments.

AT FIRST YOU WILL NOT SUCCEED: NEGOTIATING FOR CARE IN THE CONTEXT OF HEALTH REFORM

In the majority of the literature on the social organization of care work, care is often defined in more traditional terms to refer to work on or directly related to the body. In this paper, we would like to venture beyond the body to elaborate upon a particular type of care work – negotiating care – that involves negotiations and sometimes petitions for the purpose of securing care. It is a concept that was salient in a comparative study of the experiences of health care providers with the increasing management of health care in Canada and the United States. For physicians and nurses in both settings we find a sense of the increasing burden of negotiating for care for patients – particularly textually mediated negotiations – as the access to and amount of care is increasingly limited through managed care policies. Moreover, the contexts for these negotiations are continually in flux exacerbating the time devoted to negotiate care. It is in the U.S. context, however, that textual negotiation of care is most extensive and differs in terms of audience – insurers as opposed to providers – and purpose – securing payment and not just care.