Linda McGillis Hall

Nurse staffing models, nursing hours, and patient safety outcomes.

Background Data Limited research has been conducted examining the effect of nurse staffing models on costs and patient outcomes. Objective The objective of this study was to evaluate the effect of different nurse staffing models on costs and the patient outcomes of patient falls, medication errors, wound infections, and urinary tract infections. Methods A descriptive correlational study was conducted in all of the 19 teaching hospitals in Ontario, Canada. The sample comprised hospitals and adult medical, surgical, and obstetric inpatients within those hospitals. Results The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. Nurse staffing models that included a lower proportion of professional nursing staff in the mix used more nursing hours in this study. Conclusions The results of this study suggest that a higher proportion of professional nurses in the staff mix (RNs/RPNs) on medical and surgical units in Ontario teaching hospitals are associated with lower rates of medication errors and wound infections. Higher patient complexity was associated with greater patient use of nursing care resources.

Nurse staffing models as predictors of patient outcomes.

Background. Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. Objective. The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. Research Design. A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. Subjects. The sample comprised hospitals and adult medical–surgical and obstetric inpatients within those hospitals. Measures. The patient’s functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. Results. The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. Conclusions. The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.

A Psychometric Analysis of the Patient Satisfaction With Nursing Care Quality Questionnaire: An Actionable Approach to Measuring Patient Satisfaction

Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement.

Losing the Moment: Understanding Interruptions to Nurses' Work

Interruptions in the nursing work environment can have significant, detrimental effects on patient safety. This mixed-method study used work observation and focus groups to explore interruptions in nursing work. A large number of interruptions were reported. Causes of interruptions are analyzed, and systems processes for reducing these in the future are discussed.

Outcomes of interventions to improve hospital nursing work environments.

Objective: The impact of interventions designed to improve the nursing work environment on patient and nurse outcomes was examined. Background: Nursing work environments have been characterized as contributing to patient outcomes as a result of organizational management practices, workforce deployment, work design, and organizational culture. Methods: This quasi-experimental study involved 16 unit managers, 1,137 patients, and 296 observations from registered nurses over time. Results: After participation in the intervention, study nurses reported higher perceptions of their work and work environment. Demographic nurse, unit, and hospital characteristics also had an impact on the work environment and outcomes. Conclusions: Findings in this study highlight the importance of understanding factors in the work environment that influence patient and nurse outcomes.

Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak.

TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak.

Nurse staffing, care delivery model, and patient care quality.

Little research has been conducted examining the linkages between nurse staffing and care delivery models in relation to patient care quality. Nurses in this study perceive that an all-RN staffing model is associated with better quality outcomes for patients, and that staffing models that include professional and unregulated staff may pose a challenge for unit-based communication and the coordination of care. Patient care delivery models were also important predictors of the quality outcomes studied.

The historical social positioning of nursing and medicine: implications for career choice, early socialization and interprofessional collaboration

Abstract For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two professions and their relationships with and among each other in relation to career choice, early socialization and patient care delivery. An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.

Job satisfaction and intentions to leave of new nurses

Turnover of newly graduated nurses is of significant concern. There are continuing reports that new graduates struggle during the transition to the work setting. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job satisfaction and intention to leave of new nurses utilising Karaseks Job Demands-Control-Support model. A cross-sectional mailed survey was used to gather data. The sample comprised 232 new nurses working in acute care in Canada. Job demands, social support from both supervisors and coworkers and self-efficacy were significantly related to job dissatisfaction, while demands and support from coworkers were related to intention to leave the job. Identifying factors that contribute to the job satisfaction and intentions to leave of new nurses is a first step in developing interventions to assist nurses who are just beginning their careers.

Media Portrayal of Nurses' Perspectives and Concerns in the SARS Crisis in Toronto

Purpose: To describe nursing work life issues as portrayed in the media during the SARS crisis in Toronto. Methods: Content analysis of local and national news media documents in Canada. Media articles were sorted and classified by topic, and themes were identified. Findings: Themes were: (a) changing schemas of nursing practice: the new normal; (b) barriers to relational nursing work; (c) work life concerns: retention and recruitment; (d) nursing virtue: nurses as heroes and professionals; (e) paradoxical responses to nurses from the community; and (f) leadership in nursing during the SARS crisis. Conclusions: This analysis enhanced understanding of how nurses are portrayed in the media, but it indicated the significance of quality of work life and issues about work‐home life. Some descriptions of the care and caring of nurses have made nursing seem like an important and influential profession to potential applicants who might previously have dismissed nursing as a career.