Contract Nurses Research Articles

Effects of Outsourced Nursing on Quality Outcomes in Long-term Acute-Care Hospitals

Use of outsourced nurses is often a stop-gap measure for unplanned vacancies in smaller healthcare facilities such as long-term acute-care hospitals (LTACHs). However, the relationship of utilization levels (low, medium, or high percentages) of nonemployees covering staff schedules often is perceived to have negative relationships with quality outcomes. To assess this issue, the authors discuss the outcomes of their national study of LTACH hospitals that indicated no relationship existed between variations in percentage of staffing by contracted nurses and selected outcomes in this post-acute-care setting.

Investigation of job satisfaction and its related factors of contract nurses in military hospital

Objective To explore the job satisfaction and its related factors of contract nurses in military hospital. Methods A cross-sectional survey design utilizing questionnaires was selected to fulfill the research objective. The research assistants distributed 929 questionnaires to nurses, and 890 nurses completed the questionnaire. Results Regarding the overall job satisfaction, almost half of respondents were dissatisfied (50.2%). Respondents' characteristics had an impact on job satisfaction. Nurses were dissatisfied with extrinsic rewards, scheduling and family/work balance. Conclusions The contract nurses were dissatisfied with their job. Innovative and adaptable managerial interventions need to be taken in order to improve nurses' job satisfaction and to strengthen their intention to stay. Key words: Military hospital; Contract nurses; Job satisfaction; Related factors

Investigation on job burnout among nurses in the department of gynaecology and obstetrics

Objective To study on job burnout of nurses in the Department of gynaecology and obstetrics,and to provide reference for promoting physical and mental health and improving nursing quality.Methods A total of 118 nurses in the department of gynaecology and obstetrics were investigated with the Maslach Burnout Inventory(MBI). Results Compared with the sample of Maslach,nurses have higher scores of Emotional Exhaustion and lower scores of Depersonalization and Personal Accomplishment(P ＜ 0. 01); The degree of job burnout of elementary and contracted nurses had significant difference compared with that of intermediate and registered nurses respectively(P ＜ 0. 05). Married nurses had higher scores of Emotional Exhaustion than unmarried nurses(P ＜ 0. 01),while there were no significant difference in the scores of Depersonalization and Personal Accomplishment(P ＞ 0. 05). Conclusions The nursing managers should pay close attention to job burnout of nurses in the Department of gynaecology and obstetrics and take effective measures to improve their job burnout and guarantee high nursing quality. Key words: Job burnout; Maslach burnout inventory; Department of gynaecology and obstetrics

Research on the correlation between psychiatric nurse burnout and demographic variables

Objective To explore the correlation between psychiatric nurse burnout and demographic variables. Methods A total of 160 nurses were investigated with Burnout Questionnaire and self-designed generally questionnaire. Results Various dimensions of job burnout scores by 160 nurses were lower than the Maslach samples (P ＜0. 01 ), the detection rate of severe burnout were 22.5% for the emotional exhaustion,6.9% for depersonalization, 50% for low personal accomplishment respectively; Male nurses burnout was more than female nurses (P＜ 0.05 ); older and higher titles groups got more serious emotional exhaustion. Single nurses, nurses of secondary school education, primary nurses had the lowest sense of personal achievement. 6 to 15 years old nurses had the most serious personalized care and low personal accomplishment. Contract nurses emotional exhaustion was lower than formal nurses, the differences had statistically significant (P＜0.05 ).Conclusions The psychiatric nurses had serious burnout and generally had low personal accomplishment;besides, the psychiatric nurses' burnout depends on the different demographic variables. The differences showed significant. Key words: Psychiatric nurses; Job burnnout; Demographic

An investigation of turnover intention and reasons of contract nurses in the third level hospital of PLA

Objective To analyze the turnover intention and reasons of contract nurses and explore the intervention methods in order to decrease the turnover intention. Methods Two handred contract nurses came from the third level hospital of PLA in BeiJing were investigated by the Nurse' s Basic Information Schedule Table, the Turnover Intention Questionnaire, and the Turnover Reasons Questionnaire. All of the data were collected and analyzed. Results The scores of turnover intention were (17.29 ± 3.82) and 73.63% of contract nurses had high turnover intentions. The indictors including Age, income, educational background, the time of working and night shift affected the turnover intention of nurses. The reasons of turnover tension were the low welfare, the high working stress, absence of professional value, dissatisfied with management policy and the others factors. Conclusions The managers of the hospitals should take effective measures to reduce the turnover intention and pay more attention to improve the welfare, management pohcy, working environment and developmental opportunities for contact nurses. Key words: Engaging System Nurses; Turnover Intention; Reason; Measure

Study on the present situation of job satisfaction and the relationship between job satisfaction and turnover intention in contract nurses

Objective To analyze the present situation of job satisfaction and the relationship between job satisfaction and turnover intention of contract nurses. Methods 200 subjects were obtained by using proportional stratified random sampling method. Data collecting was conducted in Qilu Hospital, The Second Hospital of Shandong University, as well as Shandong Provincial Hospital Research instruments used in this study has three parts, including the demographic questionnaire, the nurses 'job satisfaction scale and the turnover intention scale. Results The level of the overall job satisfaction among contract nurses was at a medium level. The nine subscales of job satisfaction in ascending sequence were salary and weffare, work -family balance, administration and hospital policy, professional opportunities, Scheduling and work conditions, interpersonal relationships, performance and responsibility, professional traits, recognition and praise. There were negative correlations between the contract nurses job satisfaction scales and the turnover intention scale. The stepwise multiple regression analysis indicated that salary and and interpersonal relationships were the predictors of turnover intention. Conclusions The level of the overall job satisfaction among contract nurses was at a medium level. It is important to improve the job satisfaction of contract nurses, especially in their salary and welfare and interpersonal relationships, and this will decrease the turnover intention among them. Key words: Contract nurses; Job satisfaction; Turnover intention

Sequential and Simultaneous Decision Making for Optimizing Health Care Resource Flexibilities

ABSTRACTHealth care administrators commonly employ two types of resource flexibilities (demand upgrades and staffing flexibility) to efficiently coordinate two critical internal resources, nursing staff and beds, and an external resource (contract nurses) to satisfy stochastic patient demand. Under demand upgrades, when beds are unavailable for patients in a less acute unit, patients are upgraded to a more acute unit if space is available in that unit. Under staffing flexibility, nurses cross‐trained to work in more than one unit are used in addition to dedicated and contract nurses. Resource decisions (beds and staffing) can be made at a single point in time (simultaneous decision making) or at different points in time (sequential decision making). In this article, we address the following questions: for each flexibility configuration, under sequential and simultaneous decision making, what is the optimal resource level required to meet stochastic demand at minimum cost? Is one type of flexibility (e.g., demand upgrades) better than the other type of flexibility (e.g., staffing flexibility)? We use two‐stage stochastic programming to find optimal resource levels for two nonhomogeneous hospital units that face stochastic demand following a continuous, general distribution. We conduct a full‐factorial numerical experiment and find that the benefit of using staffing flexibility on average is greater than the benefit of using demand upgrades. However, the two types of flexibilities have a positive interaction effect and they complement each other. The type of flexibility and decision timing has an independent effect on system performance (capacity and staffing costs). The benefits of cross‐training can be largely realized even if beds and staffing levels have been determined prior to the establishment of a cross‐training initiative.

Study on the current situation of work values of contract nurses and the related factors

Objective To understand the current situation of work values and the needs of contract nurses, in order to provide the evidence of effective nursing human resources management. Methods 979 contract nurses in 7 3-Class general hospitals in Chengdu were surveyed by using Work Value Questionnaires. Results The top 3 dimensions of work values of contract nurses were relationship, achievement and economic rewards. Score of the dimension of economic rewards had significant difference among the nurses with different ages (P=0.004). Score of the dimension of social communications had significant difference among the nurses with different marriage status (P=0.005). Contract nurses with different work experiences gave different scores to economic rewards, social communications and security (P<0.01). Score of the dimension of intellectual stimulation had significant difference among the nurses with different professional titles (P=0.030). Conclusions Relationship, personal achievement and economic reward play important roles in the value system of contract nurses. Age, marriage status, work experiences and professional titles have influence on work value of contract nurses. Key words: Questionnaires; Contract nurses; Work values

Comparative study on the job satisfaction degree between contract nurses and formal nurses

Objective The purpose of this study was to compare the differences of job satisfaction degree between contract nurses and formal nurses. Methods 350 incumbency clinical nurses were ob-tained from 3 provincial and grade three A hospitals(including nurses in internal medicine, surgical,gyne-cologic,pediatric,emergency departments and ICU). Research instruments used in this study included the self-designed demographic questionnaire and the nurses' job satisfaction scale. Results The level of the overall job satisfaction degree among contract nurses was lower than that of the formal nurses. Of all job satisfaction subscales, the scores of professional opportunities, performance and responsibility,salary and welfare, administration and hospital policy, interpersonal relationships among contract nurses were lower than those of formal nurses. But the scores of scheduling and work conditions, professional traits were higher than those of formal nurses. Conclusions It is advocated to adopt different management and incentive mechanisms to improve the job satisfaction degree for contract nurses according to the differ- ences between contract nurses and formal nurses, so that the nursing staff can be stabilized. Key words: Contract nurses; Formal nurses; Job satisfaction degree

Study on the professional pressure features and related factors of contract nurses in one 3A hospital

Objective To know the contract nurses'professional pressure features in one 3A hospital, nd analyze the factors of influencing the contract nurses'professional pressure.Methods 235 contract nurses ere randomly investigated by a nurse working stress scale and a self-designed general information questionnaire. Nother 125 registered nurses were regarded as the controls.Results The score of contract nurses'working ressure was(85.32±20.49),with low wage and other welfare for ranking first in priority.There was a tatistical meaning compared to the registered nurses(P<0.05).The difference had statistical meanings in the cores of different departments,reasons for selecting the nursing work,attitude to present department,work atisfactory,attitude for switching to another trade,satisfaction degree of wage,numbers of night shift among the ontract nurses(P<0.05).Conclusions The contract nurses'working pressure belongs to the middle level. He stressors for ranking first in priority are low wage and other welfare.Attitude to work.attitude to present epartment,satisfaction degree of wage and objective support have obvious inflences to contract nurese'working ressure. Key words: Contract nurse; Professional pressure; Influence analysis

Explanations for Persistent Nursing Shortages

This paper contributes to the economics literature on nursing market shortages by putting forward two new models that suggest three new explanations for perceived nursing shortages. The first model focuses on hospitals hiring both permanent staff nurses and temporary contract nurses. It shows that hiring both classes of nurses can represent optimizing behavior, and that an interesting kind of perceived nursing shortage results from this dual hiring. The second model posits two classes of hospitals, ``premier" and ``funds-constrained," and generates two distinct kinds of nursing shortages: economic shortages, involving unfilled, budgeted positions, and ``noneconomic" professional standards shortages. We believe that the perceived existence of professional standards shortages may be a significant explanation for the widespread impression of persistent shortages.

Status quo analysis and strategy of resignation of contracted nurses

Objective To analyze the resignation status quo of contracted nurses, so as to establish an effective management mechanism and system for them. Methods 123 contracted nurses who resigned from our hospital from 2005 to 2007 were selected, collecting their individual skill files and undertaking the statistics analysis for the reasons. Results The rate of resignation was from 10.2% to 11.2%. Among the resigned contracted nurses, 62.5% of them resigned before 25 years old;The rate of initiative resignation decreased gradually the three late years (P＜0.05);86.2% of the contracted nurses resigned in the first 5 years and 48% of them were nurses of 1～2 years;The flint three reasons of resignation were changing employment (40%), individual reasons to hometown (29%), and incompetence for occupation (13%);It was an inverse ratio between the working lifetime and the number of resigned contracted nurses who broke the promises.Conclusions It is necessary to formulate the employment specification that suits the hospital feature under the new laber contract law so as to deplete or to avoid the initiative resignation of the contracted nurses. Key words: Contracted nurse; Resignation; Specification

Investigation and analysis on the sources of stress and influential factors of contract nurses

Objective To find out the major stress sources of contract nurses and investigate their influential factors.Methods Job stressors scale was used to measure 109 contract nurses of a hospital in Beijing.Results The mean stress level of contract nurses was 2.76.The major sources of stress were nursing specialty, workload and time distritmtion and nursing to patients.There was significant difference in the job stress of iob title or section(P<0.05).Conclusions The contract nurses'job stress is in a high level.Major stress resources of contract nurses include shift work.loW salary and welfare, a little chance to get retraining and worrying about nursing disputes and mistakes etc.The degrees of contract nurses'job stress are influenced by the different section offices and job titles.The managers of the hospital and the contract nurses themselves should work together to try to alleiate the contract nurses'job stress. Key words: Contract nurses; Sources of stress; Stress; Influential factors

Study on the effect factor and working achievement of contracted nurses

Objective To realize the working achievement of contracted nurses and analyze the effect factor and working achievement,explore to increase these effective step of working achievement of contracted nurses.Methods A total of 189 contracted nurses were investigated with questionnaire by international universal nurse work stress resource scale and own design working achievement resource scale.Results The average of working achievement was 2.24±0.61,there were no relationship between working achievement with their age,educational level,marriage state and working department.But it was positive correlation with nurse years and working years.There was negative correlation with occupational stress,and there were positive correlation between laborage and welfare with working achievement,condition with continuative education,often shift work with accident and charge.Conclusion Working achievement of contacted nurses is not optimism and must ameliorate actively.Occupational stress is a primary factor of contracted nurses low working achievement,however,the manager may adopt effective step,steady contracted nurses procession and increase working quality. Key words: Contracted nurses; Occupational stress; Working achievement; Demology characteristic

Study on contracted nurses'job satisfaction

Objective To study the relevant factors affecting job satisfaction of contracted nurses in primary hospitals in Shenzhen. Methods 366 nurses in 15 hospitals are asked to give answers to the MSQ.OCQ and turnover intention questionnaires,in which the total total scores from job satisfaction,organizational commitment,turnover intentions are used as dependent variables,while the total scores from age,education,marriage,titles,duties,service and the other two scoring scales are used as independent variables for the putpose of multiple stepwise regressional analysis.Results Those contracted nurses whose ages ranging from 25 to 30 are the most unsatisfactory with their jobs,thus with the highest intention to quit,while the chief nurses are the most satisfactory with their jobs and organizational commltmemt. Conclusion Contracted nurses job satisfaction is closely relative to the following factors such as organizational commitment,age,labor relations,and turnover intentions.Targeted interventions are suggested to be taken to improve the job satisfaction of contracted nurses. Key words: Contracted nurses; Job satisfaction; Organizational commitment; Turnover intention; Influencing factors

Nurse Staffing Levels: Impact of Organizational Characteristics and Registered Nurse Supply

To assess the impact of nurse supply in the geographic areas surrounding hospitals on staffing levels in hospital units, while taking into account other factors that influence nurse staffing. Data regarding 279 patient care units, in 47 randomly selected community hospitals located in 11 clusters in the United States, were obtained directly from the hospitals from the U.S. Census report, National Council of State Boards of Nursing, and The Centers for Medicare and Medicaid Services. Cross-sectional analyses with linear mixed modeling to control for nesting of units in hospitals were conducted. For each patient care unit, the hours of care per patient day from registered nurses (RNs), LPNs, nursing assistants, and the skill-mix levels were calculated. These measures of staffing were then regressed on type of unit (intensive care, medical/surgical, telemetry/stepdown), unit size, hospital complexity, and RN supply. RN hours per patient day and RN skill mix were positively related to intensity of patient care, hospital complexity, and the supply of RNs in the geographic area surrounding the hospital. LPN hours, and licensed skill mix were predicted less reliably but appear to be used as substitutes for RNs. Overtime hours increased in areas with a lower RN supply. Vacancy and turnover rates and the use of contract nurses were not affected by nurse supply. This study is the first to show that hospital RN staffing levels on both intensive care and nonintensive care units decrease as the supply of RNs in the surrounding geographic area decreases. We also show that LPN hours rise in areas where RN supply is lower. Further research to describe the quality of hospital care in relation to the supply of nurses in the area is needed.

Investigation and analysis on the relative factors that influence contracted nurses to resign initiatively

目的 调查影响合同制护士主动离职意向的相关因素.方法 采用自行设计的问卷调查对四川省某三甲医院的234例合同护士主动离职意向的相关因素进行调查分析.结果 不同婚姻状况及不同职称的合同制护士对主动离职意向存在显著性差异,已婚者及职称较高的合同制护士主动离职意向低,而未婚者及职称较低者主动离职意向高.结论 为减少合同护士主动离职意向,医院及护理管理者应关心合同制护士的家庭生活状况及职称、职位因素,增加工作满意度,提高医院人力资源管理水平,减少合同制护理人员的流失率。

Analysis of job stress and coping styles of contract nurses

目的 了解合同制护士工作压力来源、压力程度和应对方式.方法 对107名合同制护士选用护士压力源量表、焦虑自评量表(SAS)、特质应对量表进行问卷调查并进行统计学分析.结果 合同护士的总体压力水平为中度,压力主要来源于护理专业及工作、病人护理方面和工作量与时间分配方面;工作年限≥5年的合同护士压力高于＜5年的合同护士,有显著性差异(P＜0.05).合同护士的焦虑程度高于普通人群,有显著性差异(P＜0.001);9.4%的合同护士存在不同程度的焦虑症状.合同护士多采用积极应对方式,少采用消极应对方式,工作年限≥5年的合同护士比＜5年的合同护士更易采取积极应对方式,有显著性差异(P＜0.05).合同护士工作总压力与焦虑程度呈正相关(P＜0.05),病人护理方面和管理及人际关系方面与消极应对方式呈正相关(P＜0.05).结论 针对合同护士这一特殊群体,护理管理者应注意充分运用激励机制,建议关注合同护士的工作压力和心理健康状况,有针对性地采取心理知识及专业知识的培训,提高其积极应对的技巧。

A Comparison Study of Nursing Care Quality in Different Working Status Nursing Staffs: An Example of One Local Hospital

To reduce costs, many hospitals are trying to adopt strategies to contract out their nursing workforce. The purpose of this study is to compare the quality of health care among the following three categories of nursing workforces in public hospitals: outsourced nurses, permanently employed nurses and contracted nurses compensated based on hours worked. The research sample included 300 patients cared for by 78 nurses in insurance wards in a local public hospital. Four methods were used to evaluate care quality. They included examining medical records, interviewing nurses, observing, and interviewing patients. The study found the best care quality was delivered by permanently employed nurses followed by that delivered by contracted nurses. The worst care quality was delivered by outsourced nurses employed by agency companies contracted to the public hospital. Care quality dimensions that were statistically significant among three categories of nurses included total quality of nursing care, nursing care planning, nursing instruction, and nursing evaluation.

Medicare Patients May Exceed Therapy Caps

Medicare Patients May Exceed Therapy Caps