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Book part
Publication date: 25 July 2008

Donde Batten, Gerald Goodman and Susan M. Distefano

Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an…

Abstract

Research suggests that improving hospital work environments and solving the nursing shortage are critical to improving patient care. The Houston–Galveston region created an aggressive approach to this issue by forming an unusual coalition of business, university, and hospital leaders and using a quality improvement approach. Four years later, the project has achieved over 40% participation among hospitals in the 13-county region and includes 50 hospitals employing approximately 15,000 registered nurses. The data that have been collected by this collaborative to date suggests that hospitals are taking action to improve outcomes by modifying their key initiatives to address the attributed causes of poor work environments. From 2004 to 2005, executives of top performing hospitals increasingly attributed successful work environment outcomes to an emphasis on management development and executive-driven initiatives, de-emphasizing specific employee behavior, process, and outcome-based initiatives.

Details

Patient Safety and Health Care Management
Type: Book
ISBN: 978-1-84663-955-5

Book part
Publication date: 11 December 2007

Helen Kohlen

The tradition of medicine has until now been characterized by an aspiration to provide as complete as possible a service of care to the populations to which it owes…

Abstract

The tradition of medicine has until now been characterized by an aspiration to provide as complete as possible a service of care to the populations to which it owes responsibility. The same holds for nursing and caring practices, but the tradition is loosening. Despite the collective assumption that medical and nursing practice rests on solid grounds of knowledge and is framed by a caring ethos, change in practice not only has typically come about in a complex and diffuse fashion, but has also come along with sacrifices, losses and deficits.

Details

Bioethical Issues, Sociological Perspectives
Type: Book
ISBN: 978-0-7623-1438-6

Article
Publication date: 3 May 2011

Ari Mwachofi, Stephen L. Walston and Badran A. Al‐Omar

Nurses heavily influence patient care quality and safety. This paper aims to examine socioeconomic and organizational/system factors affecting patient safety and quality…

3772

Abstract

Purpose

Nurses heavily influence patient care quality and safety. This paper aims to examine socioeconomic and organizational/system factors affecting patient safety and quality perceptions.

Design/methodology/approach

A questionnaire was constructed to gather demographic, managerial support, information technology implementation and integration information. Data were collected from nurses in five Riyadh hospitals, Saudi Arabia. Registered nurses working in hospital departments participated in the survey. A total of 566 completed questionnaires were returned. Subsequent data were analyzed through binary logistic regression.

Findings

Factors that improve patient safety and the likelihood that nurses use their own facility include: fewer visible errors; ability to communicate suggestions; information technology support and training; and a confidential error reporting system.

Research limitations/implications

The survey was a cross‐sectional study. Consequently, it is difficult to establish causation. Furthermore, nursing in these hospitals is dominated by foreign nationals. Also, as with all surveys, this research may be subject to response bias. Although the questionnaire was randomly distributed, there were no mechanisms to assure privacy and minimize peer influence. The high positive patient safety perceptions may be influenced by either individual or peer biases.

Practical implications

Nurses are important communicators; especially about hospital safety and quality. The research informs leaders about areas that need considering and improving. Findings indicate that system factors, including functional feedback, suggestions, and error reporting significantly affect patient safety improvements. Likewise, nurse education to operate their information systems has positive effects. Healthcare leaders need to understand factors that affect patient safety perceptions when creating a patient safety culture.

Originality/value

Few international articles examine the factors that influence nurses' patient safety perceptions or examine those factors that affect these perceptions. This paper adds value by researching what influences patient safety perceptions among Riyadh nurses.

Details

International Journal of Health Care Quality Assurance, vol. 24 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 October 2004

Jane McCusker, Nandini Dendukuri, Linda Cardinal, Johanne Laplante and Linda Bambonye

The literature suggests that improvements in nurses' work environments may improve the quality of patient care. Furthermore, monitoring the work environment through staff surveys…

3168

Abstract

The literature suggests that improvements in nurses' work environments may improve the quality of patient care. Furthermore, monitoring the work environment through staff surveys may be a feasible method of identifying opportunities for quality improvement. This study aimed to confirm five proposed sub‐scales from the Nursing Work Index – Revised (NWI‐R) to assess the nursing work environment and the performance of these sub‐scales across different units in a hospital. Data were derived from a cross‐sectional survey of 243 nurses from 13 units of a 300‐bed university‐affiliated hospital in Quebec, Canada, during 2001. Using confirmatory factor analysis, the five sub‐scales were confirmed; three of the sub‐scales had greater ability to discriminate between units. Using hierarchical regression models, “resource adequacy” was the sub‐scale most strongly associated with the perceived quality of care at the last shift. The NWI‐R sub‐scales are potentially useful for comparison of work environments of different nursing units at the same hospital.

Details

International Journal of Health Care Quality Assurance, vol. 17 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 August 2003

Greta Cummings and Carole A. Estabrooks

The study purpose was to assess the evidence on the effects of hospital restructuring that included layoffs, on nurses who remained employed, using a systematic review of the…

1625

Abstract

The study purpose was to assess the evidence on the effects of hospital restructuring that included layoffs, on nurses who remained employed, using a systematic review of the research literature to contribute to policy formation. Papers addressing research, hospital restructuring resulting in layoffs, effects on nurses, and a stated relationship between the independent and dependent variables were included. Data were extracted and the quality of each study was assessed. The final group of included studies had 22 empirical papers. The main effects were significant decreases in job satisfaction, professional efficacy, ability to provide quality care, physical and emotional health, and increases in turnover, and disruption to healthcare team relationships. Nurses with fewer years of experience or who experienced multiple episodes of restructuring experienced greater effects. Other findings remain inconclusive. Further research is required to determine if these effects are temporal or can be mitigated by individual or organizational strategies.

Details

International Journal of Sociology and Social Policy, vol. 23 no. 8/9
Type: Research Article
ISSN: 0144-333X

Keywords

Book part
Publication date: 29 July 2009

Lynn Unruh, C. Allison Russo, H. Joanna Jiang and Carol Stocks

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is…

Abstract

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

Details

Biennial Review of Health Care Management: Meso Perspective
Type: Book
ISBN: 978-1-84855-673-7

Book part
Publication date: 25 July 2008

Michal Tamuz, Cynthia K. Russell and Eric J. Thomas

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that…

Abstract

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

Details

Patient Safety and Health Care Management
Type: Book
ISBN: 978-1-84663-955-5

Article
Publication date: 23 March 2022

Xiaosong (David) Peng, Yuan Ye, Raymond Lei Fan, Xin (David) Ding and Aravind Chandrasekaran

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The…

Abstract

Purpose

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

Design/methodology/approach

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

Findings

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

Practical implications

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Originality/value

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

Details

International Journal of Operations & Production Management, vol. 42 no. 5
Type: Research Article
ISSN: 0144-3577

Keywords

Article
Publication date: 8 June 2015

Ana Shetach and Ohad Marcus

The purpose of this paper is to investigate into the relationships among citizenship behavior within medical and nursing teams, cooperation among these teams within hospital units…

1225

Abstract

Purpose

The purpose of this paper is to investigate into the relationships among citizenship behavior within medical and nursing teams, cooperation among these teams within hospital units and job satisfaction of members of those teams.

Design/methodology/approach

Data were gathered via questionnaires, administered to 107 doctors and nurses of a small hospital in Israel, regarding their job satisfaction, their evaluation of the citizenship behavior within their own professional team (medical or nursing) and the extent of cooperation of their own team with the other professional team. Preacher and Hayes’s mediation analyses were carried out on the data.

Findings

The findings show that medical–nursing cooperation mediates the relationship between citizenship behavior within the professional team (medical or nursing) and job satisfaction. When analyzed separately for doctors and nurses, results show that job satisfaction is predicted by the cooperation between the medical and nursing staff within hospital units, for nurses only. Citizenship behavior is shown to predict job satisfaction for each of the two professional sectors. Although for nurses, both factors affect their levels of job satisfaction, whereas for the doctors, cooperation affects citizenship behavior within the medical team, which, in turn, affects their job satisfaction.

Research limitations/implications

The research sample is small and culturally specific, thus limiting the generalization potential of this study.

Originality/value

The unique nature of teamwork within hospital departments is hereby investigated. The findings shed light on a critical issue of hospital human resource management, which has not been previously investigated, and may have practical implications regarding hospitals’ overall management policies.

Details

Team Performance Management: An International Journal, vol. 21 no. 3/4
Type: Research Article
ISSN: 1352-7592

Keywords

Article
Publication date: 19 December 2017

Mette Kollerup, Tine Curtis and Birgitte Schantz Laursen

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to…

Abstract

Purpose

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.

Design/methodology/approach

Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.

Findings

The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.

Research limitations/implications

The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.

Practical implications

Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.

Originality/value

This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

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