Linda Flynn

Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.

Context:Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. Objective:To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. Design, Setting, and Participants:Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. Main Outcome Measures:A 30-day inpatient mortality and failure-to-rescue. Results:The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. Conclusions:Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

Agency characteristics most valued by home care nurses: findings of a nationwide study.

The demand for home care services is continuing to rise at such a rate that the home care nursing workforce will need to double by 2020. Struggling to recruit and retain an adequate clinician supply in the midst of a severe shortage, administrators may find help in the magnet hospital approach, which focuses on creating a professional practice environment. This study identified, in a national sample of home care nurses, organizational traits reported most important in supporting nurses’ professional practice and job satisfaction.

EFFECTIVENESS OF PELVIC MUSCLE EXERCISES IN REDUCING URGE INCONTINENCE: Among Community Residing Elders

1. Urinary incontinence is a costly and prevalent problem, affecting 15% to 39% of all community residing elders. 2. Some elders suffering from urge incontinence prefer pelvic muscle exercises to bladder training as the behavioral intervention of choice. 3. Although pelvic muscle exercises are frequently associated as an intervention for stress incontinence, they have been found to be effective in significantly reducing urge incontinence. 4. Nurses are in a key position to identify and treat urinary incontinence among the elderly, and should incorporate continence restoration interventions into their practice.

Extending Work Environment Research Into Home Health Settings

Organizational attributes in work environments that support nursing practice are theoretically associated with superior nurse and patient outcomes, and lower frequencies of adverse events. This study explored associations between organizational support for nursing practice in home health care agencies and (a) the frequency of nurse-reported adverse events, (b) nurse-assessed quality of care, (c) nurse job satisfaction, and (d) nurses’ intentions to leave their employing agency. Data were collected from a sample of 137 registered nurses employed as home health staff nurses in the United States and analyzed using descriptive techniques and bivariate correlation. As anticipated, organizational support for nursing was negatively associated with nurse-reported adverse patient events and intent to leave, and positively associated with nurse-assessed quality of care and job satisfaction. These findings may be helpful to nursing administrators who seek to create work environments in home health agencies that maximize patient outcomes and nurse satisfaction.

The health practices of homeless women: a causal model

A theoretical model was developed and tested to explain the effects of learned helplessness, self-esteem, and depression on the health practices of homeless women. Data were collected from a sample of 122 homeless women recruited from six shelters. Structural equation analysis was used to evaluate the model. Analysis revealed a goodness-of-fit index of 98, indicating a good fit of the model with the data. Overall, the variables in the model accounted for 14% to 21% of the variance in the health practices of homeless women.

The importance of work environment: evidence-based strategies for enhancing nurse retention.

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses’ job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index–Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.

Association of Faculty Perceptions of Work–Life With Emotional Exhaustion and Intent to Leave Academic Nursing: Report on a National Survey of Nurse Faculty

The current and projected nurse faculty shortage threatens the capacity to educate sufficient numbers of nurses for meeting demand. As part of an initiative to foster strategies for expanding educational capacity, a survey of a nationally representative sample of 3,120 full-time nurse faculty members in 269 schools and programs that offered at least one prelicensure degree program was conducted. Nearly 4 of 10 participants reported high levels of emotional exhaustion, and one third expressed an intent to leave academic nursing within 5 years. Major contributors to burnout were dissatisfaction with workload and perceived inflexibility to balance work and family life. Intent to leave was explained not only by age but by several potentially modifiable aspects of work, including dissatisfaction with workload, salary, and availability of teaching support. Preparing sufficient numbers of nurses to meet future health needs will require addressing those aspects of work-life that undermine faculty teaching capacity.

Nurses’ Clinical Reasoning Processes and Practices of Medication Safety

In this article, we describe the depth of knowledge and skill nurses used in making decisions regarding the safe processes and practices of medication administration. Using grounded theory, we identified the essence of medication safety by nurses as the theme of clinical reasoning. Nurses used two medication safety processes within the clinical reasoning theme—maintaining medication safety and managing the environment—together with six categories of patient-focused medication safety practices in the first process and four categories of environmental-focused safety practices within the second process. These processes and practices present an emerging model of safe medication administration developed from the narratives of 50 medical-surgical nurses. This model provides researchers with the basis for the development of systemic policies for safer medication administration for patients. Health care professional educators might also find the results useful in developing curricula focused on patient safety as the foundation of quality care.

Enhancing Resource Utilization Among Pregnant Adolescents

OBJECTIVE The purpose of this study was to test the impact of a home visitation intervention on resource utilization and birth outcomes among pregnant adolescents. DESIGN This study used a quasiexperimental design that included repeated measures and a comparison group to evaluate the intervention. SAMPLE The intervention sample consisted of 83 low-income, pregnant adolescents. The comparison sample was constructed from 216 deidentified electronic birth certificate records. MEASUREMENT AND INTERVENTION: Each month, during their prenatal period, participating teens received 1 home visit by a public health-registered nurse and 1 home visit by a medical social worker for the purpose of assisting teens to access community resources, select a prenatal care provider, and make and schedule appointments. Health education and transportation to medical appointments were also provided. RESULTS There were significant increases in resource utilization, including prenatal care appointments, among intervention teens during program participation. Intervention teens made significantly more visits to their prenatal care providers than did comparison group teens. There were no significant differences, however, in mean infant birth weight between the 2 groups. CONCLUSIONS The findings indicate that the intervention may be effective in enhancing resource utilization among pregnant adolescents.

Incidence and treatment costs attributable to medication errors in hospitalized patients.

BACKGROUND A significant financial burden arises from medication errors that cause direct injury and those without patient harm that represent waste and inefficiency. OBJECTIVE To estimate the incidence, types, and causes of medication errors as well as their attributable costs in a hospital setting. METHODS For a retrospective case-control study, data were collected for 57,554 patients admitted to two New Jersey (U.S. State) hospitals during 2005-2006 as well as hospital-specific voluntary error reports from these two hospitals for the same period. Medication errors were classified into categories of stage, error type, and proximal cause, and the incidence was estimated. The costs attributable to medication errors were calculated using both the recycled prediction method, and the Blinder-Oaxaca decomposition method after propensity score matching. RESULTS Medication errors occurred at a rate of 0.8 per 100 admissions, or 1.6 per 1000 patient days. Most errors occurred at the administration stage of the medication use process. The most frequent types of errors were wrong time, wrong medication, wrong dose, and omission errors. Treatment costs attributable to medication errors were in the range of