Marianne Baernholdt

The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units

AIM The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. BACKGROUND Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. METHOD Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. RESULTS Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. CONCLUSION Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. IMPLICATIONS FOR NURSING MANAGEMENT Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Blogging through cancer: young women's persistent problems shared online.

Background: Many young women have turned to illness blogs to describe their lived experience with cancer. Blogs represent an untapped source of knowledge for researchers and clinicians. Objective: The purpose of this qualitative, exploratory study was to describe the life disruptions caused by cancer among young women, as well as to understand the facilitators and barriers in accessing healthcare services during and after active treatment. Methods: Sixteen Internet illness blogs were analyzed among women, aged between 20 and 39 years, diagnosed with cancer. These blogs were analyzed based on phenomenological qualitative methods and thematic analysis. Results: There were 4 dimensions of persistent problems that were articulated in the narratives of the young women without any relief. They included pain and fatigue, insurance and financial barriers, concerns related to fertility, and symptoms of posttraumatic stress and anxiety. Conclusion: The young women’s narratives capture fear, uncertainty, anger, and the debilitating nature of these persistent issues. Many of the women expressed their lingering physical, psychosocial, and emotional problems. Implications for Practice: Online illness narratives are a naturalistic form of inquiry that allows nurses to understand the experience of the patient through their own words and accounts. This study provides a foundation for nursing-based interventions that transcend traditional clinic experiences.

The Clinical Nurse Leader--new nursing role with global implications.

BAERNHOLDT M. & COTTINGHAM S. (2011) The Clinical Nurse Leader – new nursing role with global implications. International Nursing Review58, 74–78 Aim:  This paper describes the development of the Clinical Nurse Leader (CNL©) role and education, the CNLs impact and potential to improve quality globally. Background:  The need for clinical nurse leadership to improve the quality of health care systems while controlling costs is recognized in reports internationally. In the USA, a new nursing role, the CNL, was developed in response to such reports. Conclusion:  CNLs are masters level nurse graduates (although not necessarily recruited from a nursing background) with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This innovative role can be adapted worldwide to improve the quality of health care systems.AIM This paper describes the development of the Clinical Nurse Leader (CNL ©) role and education, the CNLs impact and potential to improve quality globally. BACKGROUND The need for clinical nurse leadership to improve the quality of health care systems while controlling costs is recognized in reports internationally. In the USA, a new nursing role, the CNL, was developed in response to such reports. CONCLUSION CNLs are masters level nurse graduates (although not necessarily recruited from a nursing background) with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This innovative role can be adapted worldwide to improve the quality of health care systems.

Developing a Global Curriculum in a School of Nursing

Nurses care for an increasingly diverse ethnic population, but nursing education may not always include the necessary global learning components necessary for students to provide the most culturally appropriate and patient-centered care. Although much of the literature already attends to the importance of international experiences, this article focuses on an initiative to develop an on-campus global curriculum in a school of nursing. Through a global framework informed by a literature review and surveys of faculty and courses, a task force delivered two faculty workshops. The first focused on cultural self-awareness and cultural competence development in both faculty and students. The second workshop focused on how to incorporate a global learning objective into course syllabi. This article discusses the goals, format, and outcomes of each workshop, highlighting the importance of faculty development and the implications for other institutions to pursue this type of initiative.

Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997-2012.

Purpose: To describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012. Design: Longitudinal retrospective design Methods: Descriptive analysis of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample data. Findings: A total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44–65 years increased. LOS decreased from 5 to 3 days. Charges more than doubled, from

Relationship of adverse events and support to RN burnout.

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A Pilot Study of Staff Nursesʼ Perceptions of Factors That Influence Quality of Care in Critical Access Hospitals

53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased. Conclusion: We found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community‐based settings. Clinical Relevance: Findings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and postacute settings.

Racial/Ethnic Perspectives on the Quality of Hospice Care

Registered nurse (RN) “second victims” are RNs who are harmed from their involvement in medical errors. This study used the conceptual model nurse experience of medical errors and found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).

Differences in Pediatric Non-Interventional Radiology Procedural Sedation Practices and Adverse Events by Registered Nurses and Physicians

Knowledge is limited about quality of care (QOC) in rural hospitals, including the smallest hospitals, critical access hospitals. Staff nurses from 7 critical access hospitals identified items important for QOC across 4 levels of care: patients, microsystems, organizations, and environments. Several items were unique to critical access hospitals. Most QOC items were at the microsystem level, yet few of these items are routinely measured. These findings offer beginning evidence about how to advance QOC evaluations in rural hospitals.

Performance-Based Outcomes of Inpatient Rehabilitation Facilities Treating Hip Fracture Patients in the United States

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).