In the report To Err is Human (1999), the National Academy of Medicine called for national action... more In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016
IntroductionThe increasing burden of mental distress reported by healthcare professionals is a ma... more IntroductionThe increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals.Methods and analysisMagnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses’ and physicians’ well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be col...
BACKGROUND In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared ... more BACKGROUND In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses. PURPOSE The purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses. METHODS Logistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016. FINDINGS Higher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality. DISCUSSION Findings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.
Background Despite evidence suggesting higher quality and safer care in hospitals with comprehens... more Background Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. Objective The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety. Methods This study was a secondary analysis of nurse and hospital survey data. Unadjusted and adjusted logistic regression models were used to assess the relationship between EHR adoption level, work environment, and a set of EHR usability and quality/safety outcomes. The sample included 12,377 nurses working in 353 hospitals. Results In fully adjust...
ObjectivesThe purpose of this study is twofold: (1) to describe the quality of end‐of‐life care i... more ObjectivesThe purpose of this study is twofold: (1) to describe the quality of end‐of‐life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end‐of‐life care quality.DesignCross‐sectional analysis of multiple linked secondary data sources.PARTICIPANTS and SETTINGA total of 12,870 direct care registered nurses in 491 acute‐care hospitals.MeasurementsMeasures of end‐of‐life care quality and nurse practice environment were derived from the 2016 RN4CAST‐US survey of nurses. Nurses reported on end‐of‐life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale.ResultsMost nurses gave their hospitals an unfavorable evaluation of end‐of‐life care overall (58%) and said patients often experience painful procedures that were unlikely t...
Background: Evidence shows hospitals with better nursing resources have better outcomes but few s... more Background: Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change. Objectives: To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety. Research Design: Multilevel logistic response models, using data from a panel of 737 hospitals in which cross-sections of nurse informants surveyed in 2006 and 2016, were used to simultaneously estimate longitudinal and cross-sectional associations between nursing resources, quality of care, and patient safety. Measures: Nursing resources included hospital-level measures of work environments, nurse staffing, and nurse education. Care quality was measured by overall rating of care quality, confidence in patients managing care after discharge, confidence in management resolving patient care problems; patient safety was measured by patient safety gr...
Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IH... more Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. To determine the association between nurse staffing, nurse work environments, and IHCA survival. Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Each additional patient per nurse on medical-surgical units ...
ObjectiveTo examine the relationship between Magnet recognition, an indicator of nursing excellen... more ObjectiveTo examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.Data SourcesThis secondary analysis includes cross‐sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center.Study DesignWe conducted a retrospective observational study.Data CollectionUsing common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non‐Magnet hospitals.Principal FindingsPatients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication.ConclusionsMagnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals.
The authors regret that item descriptions within Table 3 were published without the necessary per... more The authors regret that item descriptions within Table 3 were published without the necessary permissions. We would e to advise our readers that the items in Table 3 are from the Maslach Burnout Inventory, copyright (c) 1996 Wilmar B. haufeli, Michael P. Leiter, Christina Maslach, & Susan E. Jackson. All rights reserved. The inventory may not be used without rmission of the publisher, Mind Garden, Inc. www.mindgarden.com e correct table is published below:
The aim of this study is to determine whether use of supplemental registered nurses (SRNs) from a... more The aim of this study is to determine whether use of supplemental registered nurses (SRNs) from agencies is associated with patients' satisfaction. Employment of SRNs is common, but little is known about whether their use is associated with patients' satisfaction with hospital care. Cross-sectional survey data from nurses in 427 hospitals were linked to American Hospital Association data and patient data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We found little evidence that patients' satisfaction with care is related to the use of SRNs. After other hospital and nursing characteristics were controlled, greater use of SRNs was not associated with patients' global satisfaction, including whether they would rank their hospital highly or recommend their hospital, nor was it associated with nurse communication, medication explanation, or pain control. Employment of SRNs does not detract from patients' overall satisfaction or sat...
Context: California is the first and only state to implement a patient-tonurse ratio mandate for ... more Context: California is the first and only state to implement a patient-tonurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care-safety-net hospitals-remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods: We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings: The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safetynet hospitals following the mandate, while the skill mix remained essentially
This study sought to determine whether there were differences in acquired immunodeficiency syndro... more This study sought to determine whether there were differences in acquired immunodeficiency syndrome (AIDS) patients' satisfaction with inpatient nursing care on dedicated AIDS units compared with conventional, multidiagnosis medical units. Interview data were collected from more than 600 consecutive AIDS admissions in 40 patient care units in 20 hospitals in 11 high AIDS incidence cities. Ten hospitals with dedicated AIDS units were matched with comparable hospitals treating AIDS patients on multidiagnosis medical units. AIDS patients' satisfaction with nursing care on dedicated AIDS units was compared with AIDS patients' satisfaction with care on scattered-bed units in the same hospital and with AIDS patients' satisfaction on scattered-bed units in different, matched hospitals without dedicated units. Interhospital differences that were not controlled by design were controlled statistically, as were differences in patient characteristics and illness severity. Acquired immunodeficiency syndrome patients receiving care on dedicated AIDS units were significantly more satisfied with their nursing care. In hospitals with units of both types, dedicated AIDS units had a higher proportion of white patients, men, and homosexuals, whereas scattered-bed units had more minority patients and intravenous drug users. Controlling for these factors as well as for differences in illness severity and interhospital differences in patient satisfaction did not diminish the positive AIDS unit effect on patient satisfaction. Dedicated AIDS units achieve higher levels of satisfaction among patients with AIDS than general medical units. There is no evidence that patients feel isolated or stigmatized on dedicated AIDS units compared with patients on general units, and many patients have a clear preference for dedicated units.
ObjectivesTo explore differences in the incidence of postoperative complications between three ra... more ObjectivesTo explore differences in the incidence of postoperative complications between three racial and ethnic groups (white, black, Hispanic) before and after taking into account potentially confounding patient and hospital characteristics.DesignCross‐sectional study using 2006 to 2007 administrative discharge data from hospitals in four states (CA, PA, NJ, FL) linked to American Hospital Association Annual Survey data and data from the U.S. Census. Risk‐adjusted logistic regression models were used in the analyses.SettingSix hundred U.S. adult nonfederal acute care hospitals.ParticipantsIndividuals aged 65 and older undergoing general, orthopedic, or vascular surgery (N = 587,314; 86% white, 6% black, 8% Hispanic).MeasurementsThirteen frequent postoperative complications.ResultsWhen considered without controls, black patients had significantly greater odds than white patients of developing 12 of the 13 complications, by factors (ORs) ranging from 1.09 to 2.69. Hispanic patients ...
Purpose-To examine the influence of nursing-specifically nurse staffing and the nurse work enviro... more Purpose-To examine the influence of nursing-specifically nurse staffing and the nurse work environment-on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. Design-Cross-sectional secondary analysis of 2006-2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care-associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. Results-Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients' readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. Conclusions-This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients.
The research reported herein, using samples of women interviewed in the 1965 and 1970 National Fe... more The research reported herein, using samples of women interviewed in the 1965 and 1970 National Fertility Studies and the 1976 National Survey of Family Growth, shows that the sex of women’s previous children has an effect on their subsequent fertility intentions which differs at each parity. The persistence of that effect among women with two children in particular argues strongly for including sex of previous children as an independent variable in models of fertility intentions, since the decline in family size norms makes factors which affect the decision to have (or not have) a third child increasingly important.
A reanalysis of data included in a recent report by Freedman et al. (1980), using methods suggest... more A reanalysis of data included in a recent report by Freedman et al. (1980), using methods suggested by Goodman (1978), yields considerably different substantive conclusions than were arrived at by those earlier analysts. These differences clearly point out the hazards of descriptive analysis, especially of sample data which come in the form of contingency tables.
In an environment rife with controversy about patient safety in hospitals, medical error rates, a... more In an environment rife with controversy about patient safety in hospitals, medical error rates, and nursing shortages, consumers need to know how good the care is at their local hospitals. Nursing's best kept secret is the single most effective mechanism for providing that type of comparative information to consumers, a seal of approval for quality nursing care: designation of magnet hospital status by the American Nurses Credentialing Center (ANCC). Magnet designation, or recognition of the "best" hospitals, was conceived in the early 1980s when the American Academy of Nursing (AAN) conducted a study to identify which hospitals attracted and retained nurses and which organizational features were shared by these successful hospitals, referred to as magnet hospitals. In the 1990s, the American Nurses Association (ANA), through the ANCC, established a formal program to acknowledge excellence in nursing services: the Magnet Nursing Services Recognition Program. The purpose of the current study is to examine whether hospitals selected for recognition by the ANCC application process-ANCC-accredited hospitals-are as successful in creating environments in which excellent nursing care is provided as the original AAN magnet hospitals were. We found that at ANCC-recognized magnet hospitals nurses had lower burnout rates and higher levels of job satisfaction and gave the quality of care provided at their hospitals higher ratings than did nurses at the AAN magnet hospitals. Our findings validate the ability of the Magnet Nursing Services Recognition Program to successfully identify hospitals that provide highquality nursing care.
Twenty years after the onset of the AIDS epidemic and widespread recognition of health care provi... more Twenty years after the onset of the AIDS epidemic and widespread recognition of health care providers' risks of occupational exposures to bloodborne pathogens, needlestick injuries remain a prominent issue for health professionals, administrators, and policymakers. The federal Needlestick Safety and Prevention Act was approved in late 2000 and revised the 1991 Occupational Safety and Health Administration Bloodborne Pathogens Standard to require, rather than merely recommend, the use of safety-engineered sharps devices by health care workers. Specific provisions of Public Law (PL) 106-430, which took effect April 18, 2001, oblige health care facilities to adopt technology that eliminates or reduces exposures to bloodborne pathogens and to involve employees responsible for direct patient care in the evaluation and selection of safer devices for injections, intravenous (IV) access, and blood draws. 1 Various types of safety equipment to lower percutaneous injury risk became available during the 1980s.
In the report To Err is Human (1999), the National Academy of Medicine called for national action... more In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016
IntroductionThe increasing burden of mental distress reported by healthcare professionals is a ma... more IntroductionThe increasing burden of mental distress reported by healthcare professionals is a matter of serious concern and there is a growing recognition of the role of the workplace in creating this problem. Magnet hospitals, a model shown to attract and retain staff in US research, creates positive work environments that aim to support the well-being of healthcare professionals.Methods and analysisMagnet4Europe is a cluster randomised controlled trial, with wait list controls, designed to evaluate the effects of organisational redesign, based on the Magnet model, on nurses’ and physicians’ well-being in general acute care hospitals, using a multicomponent implementation strategy. The study will be conducted in more than 60 general acute care hospitals in Belgium, England, Germany, Ireland, Norway and Sweden. The primary outcome is burnout among nurses and physicians, assessed in longitudinal surveys of nurses and physicians at participating hospitals. Additional data will be col...
BACKGROUND In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared ... more BACKGROUND In 2010, the IOM recommended an increase in the proportion of bachelor's-prepared (BSN) nurses to 80% by 2020. This goal was largely based on evidence linking hospitals with higher proportions of BSN nurses to better patient outcomes. Though, evidence is lacking on whether outcomes differ by a hospital's composition of initial BSN and transitional RN-to-BSN nurses. PURPOSE The purpose of this study is to determine whether risk-adjusted odds of surgical mortality are associated with a hospital's proportion of initial BSN and transitional RN-to-BSN nurses. METHODS Logistic regression models were used to analyze cross-sectional data of general surgical patients, nurses, and hospitals in four large states in 2015 to 2016. FINDINGS Higher hospital proportions of BSN nurses, regardless of educational pathway, are associated with lower odds of 30-day inpatient surgical mortality. DISCUSSION Findings support promoting multiple BSN educational pathways to reach the IOM's recommendation of at least an 80% BSN workforce.
Background Despite evidence suggesting higher quality and safer care in hospitals with comprehens... more Background Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. Objective The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety. Methods This study was a secondary analysis of nurse and hospital survey data. Unadjusted and adjusted logistic regression models were used to assess the relationship between EHR adoption level, work environment, and a set of EHR usability and quality/safety outcomes. The sample included 12,377 nurses working in 353 hospitals. Results In fully adjust...
ObjectivesThe purpose of this study is twofold: (1) to describe the quality of end‐of‐life care i... more ObjectivesThe purpose of this study is twofold: (1) to describe the quality of end‐of‐life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end‐of‐life care quality.DesignCross‐sectional analysis of multiple linked secondary data sources.PARTICIPANTS and SETTINGA total of 12,870 direct care registered nurses in 491 acute‐care hospitals.MeasurementsMeasures of end‐of‐life care quality and nurse practice environment were derived from the 2016 RN4CAST‐US survey of nurses. Nurses reported on end‐of‐life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale.ResultsMost nurses gave their hospitals an unfavorable evaluation of end‐of‐life care overall (58%) and said patients often experience painful procedures that were unlikely t...
Background: Evidence shows hospitals with better nursing resources have better outcomes but few s... more Background: Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change. Objectives: To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety. Research Design: Multilevel logistic response models, using data from a panel of 737 hospitals in which cross-sections of nurse informants surveyed in 2006 and 2016, were used to simultaneously estimate longitudinal and cross-sectional associations between nursing resources, quality of care, and patient safety. Measures: Nursing resources included hospital-level measures of work environments, nurse staffing, and nurse education. Care quality was measured by overall rating of care quality, confidence in patients managing care after discharge, confidence in management resolving patient care problems; patient safety was measured by patient safety gr...
Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IH... more Although nurses are the most likely first responders to witness an in-hospital cardiac arrest (IHCA) and provide treatment, little research has been undertaken to determine what features of nursing are related to cardiac arrest outcomes. To determine the association between nurse staffing, nurse work environments, and IHCA survival. Cross-sectional study of data from: (1) the American Heart Association's Get With The Guidelines-Resuscitation database; (2) the University of Pennsylvania Multi-State Nursing Care and and Patient Safety; and (3) the American Hospital Association annual survey. Logistic regression models were used to determine the association of the features of nursing and IHCA survival to discharge after adjusting for hospital and patient characteristics. A total of 11,160 adult patients aged 18 and older between 2005 and 2007 in 75 hospitals in 4 states (Pennsylvania, Florida, California, and New Jersey). Each additional patient per nurse on medical-surgical units ...
ObjectiveTo examine the relationship between Magnet recognition, an indicator of nursing excellen... more ObjectiveTo examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.Data SourcesThis secondary analysis includes cross‐sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center.Study DesignWe conducted a retrospective observational study.Data CollectionUsing common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non‐Magnet hospitals.Principal FindingsPatients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication.ConclusionsMagnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals.
The authors regret that item descriptions within Table 3 were published without the necessary per... more The authors regret that item descriptions within Table 3 were published without the necessary permissions. We would e to advise our readers that the items in Table 3 are from the Maslach Burnout Inventory, copyright (c) 1996 Wilmar B. haufeli, Michael P. Leiter, Christina Maslach, & Susan E. Jackson. All rights reserved. The inventory may not be used without rmission of the publisher, Mind Garden, Inc. www.mindgarden.com e correct table is published below:
The aim of this study is to determine whether use of supplemental registered nurses (SRNs) from a... more The aim of this study is to determine whether use of supplemental registered nurses (SRNs) from agencies is associated with patients' satisfaction. Employment of SRNs is common, but little is known about whether their use is associated with patients' satisfaction with hospital care. Cross-sectional survey data from nurses in 427 hospitals were linked to American Hospital Association data and patient data from the Hospital Consumer Assessment of Healthcare Providers and Systems survey. We found little evidence that patients' satisfaction with care is related to the use of SRNs. After other hospital and nursing characteristics were controlled, greater use of SRNs was not associated with patients' global satisfaction, including whether they would rank their hospital highly or recommend their hospital, nor was it associated with nurse communication, medication explanation, or pain control. Employment of SRNs does not detract from patients' overall satisfaction or sat...
Context: California is the first and only state to implement a patient-tonurse ratio mandate for ... more Context: California is the first and only state to implement a patient-tonurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care-safety-net hospitals-remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. Methods: We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. Findings: The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (−0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safetynet hospitals following the mandate, while the skill mix remained essentially
This study sought to determine whether there were differences in acquired immunodeficiency syndro... more This study sought to determine whether there were differences in acquired immunodeficiency syndrome (AIDS) patients' satisfaction with inpatient nursing care on dedicated AIDS units compared with conventional, multidiagnosis medical units. Interview data were collected from more than 600 consecutive AIDS admissions in 40 patient care units in 20 hospitals in 11 high AIDS incidence cities. Ten hospitals with dedicated AIDS units were matched with comparable hospitals treating AIDS patients on multidiagnosis medical units. AIDS patients' satisfaction with nursing care on dedicated AIDS units was compared with AIDS patients' satisfaction with care on scattered-bed units in the same hospital and with AIDS patients' satisfaction on scattered-bed units in different, matched hospitals without dedicated units. Interhospital differences that were not controlled by design were controlled statistically, as were differences in patient characteristics and illness severity. Acquired immunodeficiency syndrome patients receiving care on dedicated AIDS units were significantly more satisfied with their nursing care. In hospitals with units of both types, dedicated AIDS units had a higher proportion of white patients, men, and homosexuals, whereas scattered-bed units had more minority patients and intravenous drug users. Controlling for these factors as well as for differences in illness severity and interhospital differences in patient satisfaction did not diminish the positive AIDS unit effect on patient satisfaction. Dedicated AIDS units achieve higher levels of satisfaction among patients with AIDS than general medical units. There is no evidence that patients feel isolated or stigmatized on dedicated AIDS units compared with patients on general units, and many patients have a clear preference for dedicated units.
ObjectivesTo explore differences in the incidence of postoperative complications between three ra... more ObjectivesTo explore differences in the incidence of postoperative complications between three racial and ethnic groups (white, black, Hispanic) before and after taking into account potentially confounding patient and hospital characteristics.DesignCross‐sectional study using 2006 to 2007 administrative discharge data from hospitals in four states (CA, PA, NJ, FL) linked to American Hospital Association Annual Survey data and data from the U.S. Census. Risk‐adjusted logistic regression models were used in the analyses.SettingSix hundred U.S. adult nonfederal acute care hospitals.ParticipantsIndividuals aged 65 and older undergoing general, orthopedic, or vascular surgery (N = 587,314; 86% white, 6% black, 8% Hispanic).MeasurementsThirteen frequent postoperative complications.ResultsWhen considered without controls, black patients had significantly greater odds than white patients of developing 12 of the 13 complications, by factors (ORs) ranging from 1.09 to 2.69. Hispanic patients ...
Purpose-To examine the influence of nursing-specifically nurse staffing and the nurse work enviro... more Purpose-To examine the influence of nursing-specifically nurse staffing and the nurse work environment-on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. Design-Cross-sectional secondary analysis of 2006-2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care-associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. Results-Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients' readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. Conclusions-This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients.
The research reported herein, using samples of women interviewed in the 1965 and 1970 National Fe... more The research reported herein, using samples of women interviewed in the 1965 and 1970 National Fertility Studies and the 1976 National Survey of Family Growth, shows that the sex of women’s previous children has an effect on their subsequent fertility intentions which differs at each parity. The persistence of that effect among women with two children in particular argues strongly for including sex of previous children as an independent variable in models of fertility intentions, since the decline in family size norms makes factors which affect the decision to have (or not have) a third child increasingly important.
A reanalysis of data included in a recent report by Freedman et al. (1980), using methods suggest... more A reanalysis of data included in a recent report by Freedman et al. (1980), using methods suggested by Goodman (1978), yields considerably different substantive conclusions than were arrived at by those earlier analysts. These differences clearly point out the hazards of descriptive analysis, especially of sample data which come in the form of contingency tables.
In an environment rife with controversy about patient safety in hospitals, medical error rates, a... more In an environment rife with controversy about patient safety in hospitals, medical error rates, and nursing shortages, consumers need to know how good the care is at their local hospitals. Nursing's best kept secret is the single most effective mechanism for providing that type of comparative information to consumers, a seal of approval for quality nursing care: designation of magnet hospital status by the American Nurses Credentialing Center (ANCC). Magnet designation, or recognition of the "best" hospitals, was conceived in the early 1980s when the American Academy of Nursing (AAN) conducted a study to identify which hospitals attracted and retained nurses and which organizational features were shared by these successful hospitals, referred to as magnet hospitals. In the 1990s, the American Nurses Association (ANA), through the ANCC, established a formal program to acknowledge excellence in nursing services: the Magnet Nursing Services Recognition Program. The purpose of the current study is to examine whether hospitals selected for recognition by the ANCC application process-ANCC-accredited hospitals-are as successful in creating environments in which excellent nursing care is provided as the original AAN magnet hospitals were. We found that at ANCC-recognized magnet hospitals nurses had lower burnout rates and higher levels of job satisfaction and gave the quality of care provided at their hospitals higher ratings than did nurses at the AAN magnet hospitals. Our findings validate the ability of the Magnet Nursing Services Recognition Program to successfully identify hospitals that provide highquality nursing care.
Twenty years after the onset of the AIDS epidemic and widespread recognition of health care provi... more Twenty years after the onset of the AIDS epidemic and widespread recognition of health care providers' risks of occupational exposures to bloodborne pathogens, needlestick injuries remain a prominent issue for health professionals, administrators, and policymakers. The federal Needlestick Safety and Prevention Act was approved in late 2000 and revised the 1991 Occupational Safety and Health Administration Bloodborne Pathogens Standard to require, rather than merely recommend, the use of safety-engineered sharps devices by health care workers. Specific provisions of Public Law (PL) 106-430, which took effect April 18, 2001, oblige health care facilities to adopt technology that eliminates or reduces exposures to bloodborne pathogens and to involve employees responsible for direct patient care in the evaluation and selection of safer devices for injections, intravenous (IV) access, and blood draws. 1 Various types of safety equipment to lower percutaneous injury risk became available during the 1980s.
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