General Medical-surgical Units Research Articles

The PACT Project: Feasibility of a Multidisciplinary, Multi-Faceted Intervention to Promote Goals of Care Conversations.

Patients living with serious illness generally want their physicians to facilitate Goals of Care conversations (GoCc), yet physicians may lack time and skills to engage in these conversations in the outpatient setting. The problem may be addressed by supporting multiple members of the clinical team to facilitate GoCc with the patient while admitted to the hospital. A multi-modal training and mentored implementation program was developed. A group of 10 hospitals were recruited to participate. Each hospital selected a primary inpatient unit on which to start the intervention, then expanded to a secondary unit later in the project. The number of trained facilitators (champions) and the number of documented GoCc were tracked over time. Nine of 10 hospitals completed the 3-year project. Most of the units were general medical-surgical units. Forty-eight champions were trained at the kick-off conference, attended primarily by nurses, physicians, and social workers. By the end of the project, 153 champions had been trained. A total of 51 087 patients were admitted to PACT units with 85.4% being screened for eligibility. Of the patients who were eligible, over 68% had documented GoCc. A multifaceted quality improvement intervention focused on serious illness communication skills can support a diverse clinical workforce to facilitate inpatient GoCc over time.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

A Retrospective Cohort Study of the Impact of Nurse Practitioners on Hospitalized Patient Outcomes.

The role of advanced practice providers has expanded in the hospital setting. However, little data exist examining the impact of these providers. Our purpose was to determine the effect of adding nurse practitioners in a complementary role on the quality and efficiency of care of hospitalized patients. A retrospective cohort study evaluated adult patients admitted by private physicians (without house staff or non-physician providers) to a general medical-surgical unit in an academic medical center. The admissions department allocated patients as beds became available and nurse practitioners were assigned to patients until their caseload was reached. Outcomes included length of hospital stay, in-hospital mortality, admission costs, 30-day readmissions, transfer to a more intensive care level, and discharge order time. Of the 382 patients included in this study, 263 were assigned to the nurse practitioner group. Hospital mortality was lower in the nurse practitioner group [OR 0.11 (95% CI 0.02–0.51)] as was transfer to more intensive care level [OR 0.39 (95% CI 0.20–0.75)]; however, the nurse practitioner group had longer length of stay (geometric mean = 5.80 days for nurse practitioners, 3.63 days for no nurse practitioners; p < 0.0001) and higher cost per patient (geometric mean = USD 6631 vs. USD 5121; p = 0.005). The results were unchanged when models were adjusted for potential confounders. Adding nurse practitioners can yield improved clinical outcomes (lower hospital mortality and fewer transfers to intensive care), but with a potential economic expense (longer hospital stays and higher costs).

Occupational determinants of compassion satisfaction and compassion fatigue among Filipino registered nurses

To determine the prevalence and to identify the occupational determinants of compassion satisfaction and compassion fatigue among general medical-surgical registered nurses. Compassion fatigue and compassion satisfaction are caring concepts that have been explored among nurses in specialised hospital units. However, there is paucity of studies exploring the occupational determinants among general medical-surgical registered nurses. Cross-sectional. From August-November 2017, 121 consecutively selected general medical-surgical registered Nurses from five hospitals completed a four-part survey packet composed of the participant information sheet, the Professional Quality of Life Version 5, the McCloskey-Mueller Satisfaction Scale and the Eden Warmth Survey-Employee Questionnaire. Stepwise-forward multiple linear regression was employed to identify the occupational determinants of compassion fatigue and compassion satisfaction. The STROBE checklist was followed in reporting this study (see Appendix S1). The prevalence of moderate to high levels of compassion satisfaction was 90.09% while burnout and secondary stress, the facets of compassion fatigue, had a prevalence of 74.38% and 83.47%, respectively. Among the identified occupational determinants, only job satisfaction and nurse colleague relationship positively influenced compassion satisfaction. In contrary, although higher monthly income positively influenced both dimensions of compassion fatigue, nurse colleague relationship had the strongest negative effect. Among the occupational determinants of compassion fatigue and compassion satisfaction, nurse colleague relationship had the strongest influence. This result highlights the importance of positive nurse colleague relationships and paves way for the development and initiation of appropriate strategies. The findings of this study paves way for the development of institutional policies and individualised programmes geared towards building rapport and communication among registered nurses assigned in general medical-surgical units. Likewise, the high prevalence of compassion fatigue needs further exploration to develop appropriate measures to mitigate its development among general medical-surgical nurses.

Video Recording of Nursing Care Activities in Gerontological Nursing to Compare General Units and Comprehensive Nursing Care Units

Purpose: Comprehensive nursing care services are provided for patient-centered nursing care in Korea. This study was conducted to compare differences in the frequency and elapsed time of nursing activities between comprehensive nursing care units and general medical-surgical units. Methods: This is a descriptive study design using direct observation of nursing care activities. A time and motion study on the frequency and elapsed time of nursing activities provided by nurses was conducted in the comprehensive nursing care units and general units of two small-to-medium sized hospitals. Data were collected for 64 hours in each hospital, through a two-way method using a checklist and a camera recorder. Results: The total number of nursing activities, activities provided per patient and patient safety care including clinical assessment and treatment were higher in the comprehensive nursing care units compared to general units. We found similar findings regarding the duration of nursing activities. Conclusion: Comprehensive nursing care units provide patient-centered nursing care and have a broader range of nursing activities for patient safety than general units. Assessments conducted to meet nursing needs and to promote safe nurse staffing should reflect the characteristics of the nursing tasks performed in comprehensive nursing care units.

Patient Perception of Medication Communications in the Hospital

The patient experience in the hospital has become an increasingly important measure of how well a healthcare system functions. Poor experiences as reported by patients have been associated with decreased compliance to medication instructions as well as increased recovery time from illness. While other studies have demonstrated the benefit of pharmacist counseling during patient discharge, the benefit of pharmacist intervention during the patient's hospital stay remains to be seen. This study was an institutional review board-approved pre-/post-analysis assessing patients' perception of medication communications during hospitalization in an academic teaching hospital. An attempt to counsel all patients newly admitted to the hospital was made by pharmacy personnel. Patients on general medical-surgical units participated in a brief, five-question survey prior to and following the pharmacy initiative. Overall, the patient satisfaction with medication communications increased significantly. Patients' increased satisfaction with communications about their medications was attributed to the expansion of patient counseling through the pharmacy department initiative.

Reproducibility of clinical research in critical care: a scoping review

BackgroundThe ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies.MethodsWe used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants.ResultsOverall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33–50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6–20.5% vs. 8.4%, 95% CI 6.0–10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42–68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19–52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt.ConclusionsA minority of critical care practices with research published in high-profile journals were evaluated for reproducibility; less than half had reproducible effects.

Rankings matter: nurse graduates from higher-ranked institutions have higher productivity

BackgroundIncreasing demand for baccalaureate-prepared nurses has led to rapid growth in the number of baccalaureate-granting programs, and to concerns about educational quality and potential effects on productivity of the graduating nursing workforce. We examined the association of individual productivity of a baccalaureate-prepared nurse with the ranking of the degree-granting institution.MethodsFor a sample of 691 nurses from general medical-surgical units at a large magnet urban hospital between 6/1/2011–12/31/2011, we conducted multivariate regression analysis of nurse productivity on the ranking of the degree-granting institution, adjusted for age, hospital tenure, gender, and unit-specific effects. Nurse productivity was coded as “top”/“average”/“bottom” based on a computation of individual nurse value-added to patient outcomes. Ranking of the baccalaureate-granting institution was derived from the US News and World Report Best Colleges Rankings’ categorization of the nurse’s institution as the “first tier” or the “second tier”, with diploma or associate degree as the reference category.ResultsRelative to diploma or associate degree nurses, nurses who had attended first-tier universities had three-times the odds of being in the top productivity category (OR = 3.18, p < 0.001), while second-tier education had a non-significant association with productivity (OR = 1.73, p = 0.11). Being in the bottom productivity category was not associated with having a baccalaureate degree or the quality tier.ConclusionsThe productivity boost from a nursing baccalaureate degree depends on the quality of the educational institution. Recognizing differences in educational outcomes, initiatives to build a baccalaureate-educated nursing workforce should be accompanied by improved access to high-quality educational institutions.

Evaluate the Effectiveness of Nurses' Professional Competence Approach on Their Productivity in Medical-Surgical Units

Background: Professional competence increases productivity. Nursing competency is generally viewed as a complex integration of knowledge skills, values and attitude. In clinical practice, nurses are required to apply their acquired knowledge, skills and individual traits to each situation and be able to adapt in different circumstances. Research aim: Evaluate the effectiveness of nurses' professional competence approach on their productivity in medical surgical units. Research Design: A quasi-experimental design was utilized to achieve the aim of this study. Setting: The study was conducted at Benha University Hospital, Egypt in general medical-surgical units. Sample: consisted of convenient sample of (100) nurses who are responsible for providing direct nursing care activities to patients. Tools: three tools were used for data collection; 1- nurses' knowledge questionnaire (50 items), 2- nurses' observational checklist (60 items), and 3- nurses' productivity questionnaire (60 items). These tools were used pre, post, and flow-up three months later. Result: The study indicated there were improvement in nurses' total level of knowledge, performance, and productivity after interventions of professional competence approach both immediately post and follow-up. More than three quarters of nurses their knowledge was unsatisfactory, while in the immediate post and follow-up most of nurses their knowledge improved and became satisfactory. Moreover, more than half of nurses' performance were poor practice in pre-intervention, while after implementation it was improved to and become good in both immediately post and follow-up. Furthermore, most of nurses' productivity level was low in pre-intervention, while it was improved, increased and become high in both immediate post and follow-up. Conclusion: The study concluded that the designed approach illustrated statistical significant improvement in nurses' professional competence knowledge & performance, and increasing of nurses' productivity. The mean scores of all categories slightly decreased in the follow-up after three months of the approach in comparison to immediately post. Also there were statistical significant positive correlation among nurses' knowledge & performance and productivity. Recommendation: the study recommended that the In-service training and education programs must be a continuous process for refreshing and increasing nurses’ knowledge and skills about the concept of professional competency approach as well as to emphasize nurses' productivity.

A survey of psychology practice in critical-care settings.

The aims of this survey study were to (a) examine the frequency of health-service psychology involvement in intensive and critical-care settings; (b) characterize the distinguishing features of these providers; and (c) examine unique or distinguishing features of the hospital setting in which these providers are offering services. χ2 analyses were conducted for group comparisons of health-service psychologists: (a) providing services in critical care versus those with no or limited critical care activity and (b) involved in both critical care and rehabilitation versus those only involved in critical care. A total of 175 surveys met inclusion criteria and were included in the analyses. Psychologists who worked in critical-care settings at least monthly were more likely to be at a Level-1, χ2(1, N = 157) = 9.654, p = .002, or pediatric, χ2(1, N = 158) = 7.081, p = .008, trauma center. Psychologists involved with critical care were more likely to provide services on general medical-surgical units, χ2(1, N = 167) = 45.679, p = .000. A higher proportion of rehabilitation-oriented providers provided intensive care, critical care, and neurointensive care services relative to nonrehabilitation providers. The findings indicate that health-service psychologists are involved in critical-care settings and in various roles. A more broad-based survey of hospitals across the United States would be required to identify how frequently health-service psychologists are consulted and what specific services are most effective, valued, or desired in critical-care settings. (PsycINFO Database Record

Novel Approach to Cardiac Alarm Management on Telemetry Units

General medical-surgical units struggle with how best to use cardiac monitor alarms to alert nursing staff to important abnormal heart rates (HRs) and rhythms while limiting inappropriate and unnecessary alarms that may undermine both patient safety and quality of care. When alarms are more often false than true, the nursing staff's sense of urgency in responding to alarms is diminished. In this syndrome of "clinical alarm fatigue," the simple burden of alarms desensitizes caregivers to alarms. Noise levels associated with frequent alarms may also heighten patient anxiety and disrupt their perception of a healing environment. Alarm fatigue experienced by nurses and patients is a significant problem and innovative solutions are needed. The purpose of this quality improvement study was to determine variables that would safely reduce noncritical telemetry and monitor alarms on a general medical-surgical unit where standard manufacturer defaults contributed to excessive audible alarms. Mining of alarm data and direct observations of staff's response to alarms were used to identify the self-reset warning alarms for bradycardia, tachycardia, and HR limits as the largest contributors of audible alarms. In this quality improvement study, the alarms for bradycardia, tachycardia, and HR limits were changed to "crisis," requiring nursing staff to view and act on the alarm each time it sounded. The limits for HR were HR low 45 bpm and HR high 130 bpm. An overall 89% reduction in total mean weekly audible alarms was achieved on the pilot unit (t = 8.84; P < .0001) without requirement for additional resources or technology. Staff and patient satisfaction also improved. There were no adverse events related to missed cardiac monitoring events, and the incidence of code blues decreased by 50%. Alarms with self-reset capabilities may result in an excess number of audible alarms and clinical alarm fatigue. By eliminating self-resetting alarms, the volume of audible alarms and associated clinical alarm fatigue can be significantly reduced without requiring additional resources or technology or compromising patient safety and lead to improvement in both staff and patient satisfaction.

The Return on Investment of Implementing a Continuous Monitoring System in General Medical-Surgical Units*

To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation. Return on investment analysis. A 316-bed community hospital. Medicine, surgery, or trauma patients admitted or transferred to a 33-bed medical-surgical unit. Each bed was equipped with a monitoring unit, with data collected and compared in a 9-month preimplementation period to a 9-month postimplementation period. Two models were constructed: a base case model (A) in which we estimated the total cost savings of intervention effects and a conservative model (B) in which we only included the direct variable cost component for the final day of length of stay and treatment of pressure ulcers. In the 5-year return on investment model, the monitoring system saved between $3,268,000 (conservative model B) and $9,089,000 (base model A), given an 80% prospective reimbursement rate. A net benefit of between $2,687,000 ($658,000 annualized) and $8,508,000 ($2,085,000 annualized) was reported, with the hospital breaking even on the investment after 0.5 and 0.75 of a year, respectively. The average net benefit of implementing the system ranged from $224 per patient (model B) to $710 per patient (model A) per year. A multiway sensitivity analyses was performed using the most and least favorable conditions for all variables. In the case of the most favorable conditions, the analysis yielded a net benefit of $3,823,000 (model B) and $10,599,000 (model A), and for the least favorable conditions, a net benefit of $715,000 (model B) and $3,386,000 (model A). The return on investment for the sensitivity analysis ranged from 127.1% (25.4% annualized) (model B) to 601.7% (120.3% annualized) (model A) for the least favorable conditions and from 627.5% (125.5% annualized) (model B) to 1739.7% (347.9% annualized) (model A) for the most favorable conditions. Implementation of this monitoring system was associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.

The Use of Multiple Qualitative Methods to Characterize Communication Events Between Physicians and Nurses

Despite the importance of communication to patient safety in hospital settings, we know surprisingly little about communication patterns between physicians and nurses, particularly on general medical–surgical units. Poor communication is the leading cause of preventable adverse events in hospitals, as well as a major root cause of sentinel events. The literature provides little guidance on what qualitative methods are best for capturing different types of communication events and patterns. The purpose of this study was to develop a methodology for identifying and characterizing communication events between physicians and nurses to better understand communication patterns on general medical–surgical units. We used a sequential qualitative mixed method design beginning with general observation, progressing to shadowing and focus groups of physicians and nurses who worked on two medical–surgical units at one academically affiliated U.S. Department of Veterans Affairs (VA) hospital. Each data collection method (observation, shadowing, and focus groups) had its own advantages and disadvantages for capturing communication events and patterns. Through observation we were able to see the “what”: communication activities. Shadowing was most useful for understanding “how” physicians and nurses communicated. Focus groups helped answer “why” certain patterns emerged and allowed us to further explore communication events within a group setting. By using all three methods we were able to more thoroughly characterize communication events than by using a single method alone, providing a more holistic picture of how communication occurs on an inpatient medical–surgical unit.

Innovation Pilot Study: Acute Care for Elderly (ACE) Unit—Promoting Patient-Centric Care

Older patients, defined as age 65 years or older, comprise more than 40% of admissions to the acute care environment. These patients' needs are different; cognitive impairment, chronic health issues, caregiver burden, and maintenance of functional level present challenges to healthcare organizations when caring for this population on a general medical-surgical unit. A pilot project, the creation of a six-bed Acute Care for Elderly (ACE) unit situated within a 33-bed medical-surgical unit, was established to meet the unique needs of this older patient population. Outcomes including falls, pressure ulcers, functional level (the latter as measured by the KATZ), and length of stay were examined and demonstrated marked improvement compared to similar patients outside the ACE unit. Older patients need individualized care planning by staff competent in elder care and a specialty unit to address their specific needs.

The Association of Comorbid Depression with Intensive Care Unit Admission in Patients with Diabetes: A Prospective Cohort Study

It is unknown if comorbid depression in patients with diabetes mellitus increases the risk of intensive care unit (ICU) admission. This study examined whether comorbid depression in patients with diabetes increased risk of ICU admission, coronary care unit (CCU) admission, and general medical-surgical unit hospitalization, as well as total days hospitalized, after controlling for demographics, clinical characteristics, and health risk behaviors. This prospective cohort study included 3,596 patients with diabetes enrolled in the Pathways Epidemiologic Follow-Up Study. We assessed baseline depression with the Patient Health Questionnaire-9. We controlled for baseline demographics, smoking, BMI, exercise, hemoglobin A(1c), medical comorbidities, diabetes complications, type 1 diabetes, diabetes duration, and insulin treatment. We assessed time to any ICU, CCU, and/or general medical-surgical unit admission using Cox proportional-hazards regression. We used Poisson regression with robust standard errors to examine associations between depression and total days hospitalized. Unadjusted analyses revealed that baseline probable major depression was associated with increased risk of ICU admission [hazard ratio (HR) 1.94, 95% confidence interval (95% CI)(1.34-2.81)], but was not associated with CCU or general medical-surgical unit admission. Fully adjusted analyses revealed probable major depression remained associated with increased risk of ICU admission [HR 2.23, 95% CI(1.45-3.45)]. Probable major depression was also associated with more total days hospitalized (Incremental Relative Risk 1.64, 95%CI(1.26-2.12)). Patients with diabetes and comorbid depression have a greater risk of ICU admission. Improving depression treatment in patients with diabetes could potentially prevent hospitalizations for critical illnesses and lower healthcare costs.

Safety and efficacy of continuous insulin infusion in noncritical care settings

Continuous insulin infusion (CII) to manage hyperglycemia is the accepted standard of care in the intensive care unit (ICU); however, the safety and efficacy of CII in the non-ICU setting has not been determined. This is a retrospective analysis of 200 consecutive patients receiving CII while admitted to general medical-surgical units at Emory University Hospital. We evaluated clinical outcomes and rates of hyperglycemia (blood glucose [BG] >200 mg/dL) and hypoglycemia (BG <60 mg/dL) events during CII. A total of 200 patients (age 52 +/- 16 years; male/female [M/F] 108/92) were admitted to general medicine (45%) or surgery (55%) services, 88.5% with history of diabetes and 41% treated with corticosteroids. The mean BG prior to and during the CII was 323 mg/dL and 170 mg/dL, respectively. Blood glucose of <or=150 mg/dL was the targeted goal in 85% of patients and 67% achieved a BG <or=150 mg/dL by hospital day 2. Hypoglycemia (BG <60 mg/dL) occurred at least once in 22% of patients, and severe hypoglycemia (BG <40 mg/dL) occurred in 5% of patients. Multivariate regression analyses showed that nutrition status during CII was associated with increased frequency of hyperglycemia and hypoglycemia. Compared to patients kept nil per os (NPO), oral intake during CII increased rates of hyperglycemic (P = 0.012) and hypoglycemic events (P = 0.035). CII resulted in rapid and sustained glycemic control and a rate of hypoglycemic events similar to that reported in recent ICU trials. The rates of hypoglycemic and hyperglycemic events are significantly higher in patients allowed to eat during CII.

Nurse Working Conditions and Nursing Unit Costs

The authors examined the relationship between nurse working conditions and nursing unit costs in 210 general medical, general surgical, and general medical surgical units in 112 randomly selected U.S. hospitals. Data were collected from registered nurses (N = 3,747 and 2,878), patients (N = 2,100), study coordinators, and secondary data sources. After controlling for relevant hospital, nursing unit, and patient characteristics, the authors found that good working conditions did not increase nursing unit costs. Teaching status was associated with higher costs, whereas larger unit size was associated with lower costs. Higher proportions of registered nurses and licensed practical nurse staffing were also associated with higher costs. Patient variables were not significantly related to costs. We suggest a variety of strategies that managers may use to improve working conditions.

Finding the Right Fit

At most small community hospitals, orthopaedic patients are cared for on general medical-surgical units rather than on dedicated orthopaedic units. The mixed patient population of a typical medical-surgical unit limits the amount of exposure a new graduate nurse has to care for orthopaedic patients during the unit-based orientation. In 2006, a 20-bed medical-surgical unit at a community hospital in the northeast was expecting to orient eight new graduate nurses over the course of the year. The project team recognized a need to enhance the orthopaedic portion of the unit-based orientation to prepare the graduate nurses to provide "knowledgeable and safe care" (P. ) to orthopaedic patients. This article describes the development, implementation, and evaluation of a standardized, evidence-based orthopaedic curriculum piloted in 2006. The project increased the orthopaedic competency of the preceptors, provided the new graduate nurses with a standardized introduction to orthopaedic patient care, and had an unintended benefit of improving overall staff orthopaedic knowledge that improved the consistency and quality of care for orthopaedic patients at this community hospital.

Compassion Fatigue: Are You at Risk?

Vol. 36, No. 1, January 2009 • Oncology Nursing Forum E .P., a 34-year-old oncology staff nurse, felt like she was losing control of her life. She felt a sense of dread and fatigue each morning when her alarm went off. How could she make it through one more day trying to balance her family life, her job, and caring for her mother, whose senile dementia was gradually worsening every day? E.P. could not really remember the last time she felt energetic and positive, nor could she pinpoint when she began to feel so overwhelmed. E.P. had been married for 13 years to her college sweetheart. He was in sales and worked out of the home, which, she felt, often added to the chaos of their lives. Their children came soon after marriage and were now embarking on adolescence—a daughter, 12, and a son, 10. The children seemed to fight continuously for inconsequential reasons, and her daughter was beginning to challenge E.P. in every arena: clothes, music, friends, homework, and curfew. E.P.’s husband played a passive role in their childrearing, and E.P. often did not feel supported when she attempted to set guidelines or expectations for the children. Caring for her mother was adding additional stress and her only sibling lived out of state and was not available to assist her in handling the physical, emotional, or financial aspects of their mother’s care. E.P. had studied nursing in college and began working immediately after graduation. She worked in general medicalsurgical units initially; looking back, she remembered being enthusiastic and eager to go to work every day. Nursing was not just a job for her. E.P. felt that nursing was a profession and, at one time, she had hoped to further her education and become a nurse practitioner. She did not plan to become an oncology nurse but worked the float pool for several months and soon found that her work with patients with cancer and their families was rewarding. E.P. enjoyed the challenges of working in a specialty area, learning new skills, and felt that the environment reinforced the ideals that made her enter the profession in the first place: empathy, Compassion Fatigue: Are You at Risk?

Nurse staffing and medication errors: cross-sectional or longitudinal relationships?

We used autoregressive latent trajectory (ALT) modeling to examine the relationship between change in nurse staffing and change in medication errors over 6 months in 284 general medical-surgical nursing units. We also investigated the impact of select hospital and nursing unit characteristics on the baseline level and rate of change in medication errors. We found essentially no support for a nurse staffing-medication error relationship either cross-sectionally or longitudinally. Few hospital or nursing unit characteristics had significant relationships to either the baseline level or rate of change in medication errors. However, ALT modeling is a promising technique that can promote a deeper understanding of the theoretically complex relationships that may underlie the nurse staffing-medication error relationship.