Non-direct Patient Care Research Articles

The evolution and formalization of anesthesia assistant roles across Canada.

The purpose of this Special Article is to document the evolution of the anesthesia assistant (AA) profession in Canada and summarize AA practice at Canadian institutions as it exists today, five decades after Quebec and 15years after most other provinces formalized AA practice. Through the Management Committee of the Association of Canadian University Departments of Anesthesia (ACUDA), we conducted a purposeful sampling of all ACUDA chairs or their delegates. We requested the following data: history of AAs becoming a reality in their particular province or region; potential recruitment pools; training programs and curricula; pathway to credentialing; funding, pay, retention, recruitment, and status of union representation; and metrics. Data were provided by 19 institutions in 8 provinces: Newfoundland and Labrador, Nova Scotia, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. Given the different health care governance structures across the provinces, AA roles vary in terms of its associated technical, clinical, and educational responsibilities. The role of AAs in supporting anesthesia care through equipment maintenance and assistance with airway management, resuscitation, and administration of regional anesthesia seems to be well established, as is their role in providing brief intraoperative relief for anesthesiologists during a stable period of anesthesia. Anesthesia assistant duties continue to evolve, becoming more aligned with the specific institution and less dependent on the supervising anesthesiologist. Apart from the initial metrics collected during the Ontario ACT implementation pilot projects, we are not aware of any formal metrics, current or ongoing, being collected across Canada, related to either patient safety events or perioperative efficiency. This compilation of pan-Canadian AA data shows diverse models of practice and highlights the value to patients and the health care system as a whole of incorporating these allied professionals into the anesthesia care team (ACT). The present findings allow us to offer suggestions for consideration during discussions of retention, recruitment, program expansion, and cross-country collection of metrics and other data. We conclude by making six recommendations: 1. recognize that implementation of ACTs is a key element in solving the challenge of an increasing surgical backlog; 2. develop, or facilitate the development of, metrics and increase data-sharing nationally to enable health care authorities to better understand the importance of AAs in patient safety and perioperative efficiency; 3. develop and implement funding strategies to lower the barriers to AA training such as hospital-sponsored positions, ongoing salary support, and return-of-service arrangements; 4. ensure that salaries appropriately reflect the increased level of training and added levels of responsibility of certified AAs; 5. develop long-term strategies to ensure stable funding, recruitment and retention, and a better match between the number of AA training positions and the need for newly certified AAs; and 6. engage all stakeholders to acknowledge that AAs, as knowledgeable and specifically trained assistants, not only fulfill their defined clinical role but also contribute significantly to patient safety and clinical efficiency by assuming nondirect patient care tasks.

Defining the Landscape of Educational Experiences in Transplant Infectious Diseases: A National Survey of Infectious Diseases Fellows in the United States.

Transplant infectious diseases (TID) is a growing area of expertise within infectious diseases (ID), but TID training is not standardized. Previous surveys of fellows identified opportunities to improve TID education resources but did not explore didactic, clinical, and nonclinical experiences comprehensively. The American Society of Transplantation ID Community of Practice surveyed adult and pediatric fellows in US-based general ID or dedicated TID training programs to explore their didactic exposure, clinical experiences, and non-direct patient care activities in TID. A total of 234 fellows initiated the survey, and 195 (83%) (190 general ID and 19 TID fellows, including 125 adult, 76 pediatric, and 8 combined adult-pediatric fellows) completed the entire survey. More than half of the fellows described receiving no formal curricular content on most foundational topics in transplant medicine. Almost all respondents (>90%) had some inpatient TID experience, but for >60% of fellows this was <12 weeks annually. Clinical exposure varied by fellow and patient type-in an average month rotating on an inpatient TID service, more than half of adult fellows had evaluated ≥10 kidney, liver, or hematopoietic stem cell transplant recipients but <10 heart, lung, pancreas, or intestinal recipients; pediatric fellows saw <10 of all patient types. Nearly half (46%) of general ID fellows had not spent any time in the dedicated TID clinic at their program. Few fellows had participated in protocol development, organ selection meetings, or donor evaluations. This survey highlights important gaps in TID training. Given the increasing need for TID specialists, updated curricula and educational resources are needed.

Need for additional training to be a laboratory genetic counselor-A qualitative exploration.

Opportunities for genetic counselors to work in the laboratory have grown exponentially, yet the professional development needed to serve in these roles had not been previously explored. This study aimed to identify competencies required for entry-level genetic counselors working in the laboratory, explore the perceived level of preparation of these competencies as noted by experts in the laboratories, and assess the perceived value of additional credentialing for genetic counselors practicing in these settings. Twenty genetic counselors working in the laboratory setting and five MD or PhD laboratory managers, identified through purposeful and snowball sampling and with at least 5 years of experience working in a laboratory, were interviewed using a semi-structured protocol. Transcripts were analyzed thematically using deductive and inductive coding. Key findings included the distinction of laboratory and industry roles as involving nondirect patient care and differing from genetic counseling roles in the clinical setting. Genetic counselors working in the laboratory feel well prepared to transition into this setting and provide a unique patient-focused perspective to laboratory roles, including variant interpretation, marketing, and product development. Practice-based competencies (PBCs) were translatable to those used in the laboratory, yet variant interpretation, limitations of genomics-based tests, and the business of health care were noted as important to these roles but not fully addressed in the PBCs. Additional skills were often developed through on-the-job training and interdisciplinary collaboration, but more exposure to diverse roles in genetic counseling programs' didactic and field training was recommended. The majority felt that requiring an additional post-master's credential to work in the laboratory setting may restrict movement into these roles. Several questioned their identity as genetic counselors as they were no longer providing direct patient care and/or had been dissuaded by others from pursuing a laboratory position. Research focused on professional identity among genetic counselors working in nondirect patient care roles is warranted.

Barriers and Facilitators Related to Delivery of Hospital Pharmacy Services to Women, Children, and Their Families during a Pandemic: A Qualitative Study.

When the COVID-19 pandemic was declared in March 2020, health care professionals were challenged to adapt quickly and efficiently to change their work practices. However, an evidence-informed approach has not yet been used to systematically gather data on barriers and facilitators related to delivery of hospital pharmacy services in Canada. The primary objective was to identify and describe barriers and facilitators related to the delivery of hospital pharmacy services to women, children, and their families during the COVID-19 pandemic. The secondary objective was to provide recommendations for improvement in delivery of pharmacy services to enhance patient care during pandemics. This qualitative study involved semistructured virtual interviews with pharmacists who worked in direct or nondirect patient care throughout the pandemic (since March 2020) at women's and/or children's hospitals in Canada. Individual interviews were completed virtually using conferencing software. An interview guide mapped to the Theoretical Domains Framework version 2 (TDFV2) was used to facilitate the interviews. Interviews were audio-recorded and transcribed verbatim by the principal investigator. Transcribed interviews were coded, mapped to the TDFV2, and analyzed using thematic analysis. Interviews were completed with 21 pharmacists in 7 provinces across Canada. Barriers and facilitators coded to the TDFV2 were grouped into 4 main themes: communication and collaboration, adaptability, health and well-being, and preparedness. Participants highlighted a significant number of barriers that they experienced during the COVID-19 pandemic; overall, however, participants reported that they felt prepared for subsequent waves of the COVID-19 pandemic and future pandemics.

Interview With Brandy Mathews

BM: I began my nursing career as a staff nurse in the emergency department. For personal reasons, I left the university setting and returned to my hometown where I worked in the ICU and spent a couple of years as a flight nurse. Missing the academic medical center, I returned to the university and took my first non-direct patient care and supervisory position in a new department that was focused on throughput, capacity management, and organizational growth. I learned so much about managing people and processes during this time. I was also in a position to work with data, financial metrics, and capacity management strategies, which was an experience I was lacking from my clinical background. This prompted me to pursue an advanced degree with more of a business focus. From here, I became the department director, which led to the opportunity for my current role. Currently, I am a chief nursing officer of emergency services, trauma, surgical services, general and critical care medicine teams at both of our adult hospitals. I have been blessed to work with extremely talented people and to have supervisors and mentors who gave me opportunities but also pushed me to be my best! Roxane Spitzer, PhD, RN, MBA, MA, FAAN, is Editor Emeritus of Nurse Leader, in Madison Wisconsin, and a member of the board of directors of OnSomble. She can be reached at [email protected] .

Burnout in the Pharmaceutical Activity: The Impact of COVID-19.

ImportancePharmacists are among the healthcare professionals involved in the response to the COVID-19 pandemic, maintaining essential services. In the context of restrictions and reorganization of human resources, as a result of policies recently applied to the health sector, following international guidelines, and given the scarcity of data on burnout in pharmaceutical activity, it was considered highly relevant to promote a nationwide survey aiming to collect more complete evidence on the burnout syndrome and to understand how pharmacists have viewed their work and the people they worked closely with.ObjectivesThe study aimed to assess the occurrence of pharmacist burnout and determine outcomes for each of its dimensions; identify potentially associated characteristics; and determine profiles and critical limits.DesignA cross-sectional observational study conducted by a multidisciplinary panel from the Portuguese Pharmaceutical Society (PPS). Professionals from community and hospital pharmacies who were at the forefront of the COVID-19 response were involved in (i) confirming the need and pertinence for conducting this research, (ii) identifying the main factors leading to pharmaceutical emotional distress (“burnout”), and (iii) disseminating the survey. The questionnaire was designed for digital voluntary, confidential, and anonymous participation and divided into four segments of data collection: (i) demographics, (ii) employment and workplace characterization, (iii) pandemic impact on labor activity, and (iv) burnout assessment (as described ahead).SettingAn electronic survey was addressed to all PPS members, and an account was created solely to manage the questionnaire data for the research team. The web-based and user-friendly platform Google Forms supported the data capture and provided an intuitive interface for validated data entry.ParticipantsIn a population of 15,565 pharmacists (members of the PPS), the minimum recommended sample size (Epi Info software), with a 5% margin of error and a 99.9% confidence interval, should be 1,012 individuals. A total of 1,362 pharmacists participated in the study. Of these, 91.4% (n = 1,246) were involved in direct patient care activity and 7.7% (n = 106) in non-direct patient care activity.

Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis.

Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.

Helping hands, healing hearts: A qualitative descriptive study on nurses’ perceptions on the use of volunteers in an inpatient hospital setting

BackgroundThe use of volunteers in healthcare has led to positive patient outcomes, such as delirium prevention and improved nutritional care. However, much of the existing evidence have focused on the use of volunteers within specific settings. Hence, the receptiveness of volunteers by nurses in multi-disciplinary ward context remains unclear. This can cause ineffective volunteer engagement and thus warrants attention. AimThis study aimed to explore nurses’ perceptions of volunteerism in an inpatient hospital setting. MethodsA descriptive qualitative study was conducted in the medical and surgical wards of a tertiary Singapore hospital. Nurses who had experience with engaging volunteers were recruited and interviewed using focus group discussions. Guided by data saturation, six focus group discussions were conducted, audio-recorded, transcribed verbatim, and thematically analysed. FindingsThree main themes emerged from the data. “Engaging the volunteer” illustrated nurses’ appreciation of the volunteers in engaging patients, especially in a hectic ward environment. “Extending the volunteers’ role” highlighted nurses’ desires for volunteers to expand upon their role to include direct and non-direct patient care. Lastly, “Investing in volunteers” gave rise to suggestions to strengthen volunteer programmes through proper training and volunteer retention. DiscussionFindings revealed that nurses werewere welcoming of volunteers in the inpatient setting. Discourse around allowing volunteers to partake in direct patient care revealed the emphasis nurses placed on ensuring that the volunteers had an immersive experience, while maintaining patient safety. ConclusionThis study suggests that volunteers are well-positioned to be an adjuvant to care provision in the inpatient setting.

Burnout in the Pharmaceutical Activity: The Impact of COVID-19

Objectives: Pharmacists are among the healthcare professionals involved in the response to COVID-19 pandemic, maintaining essential services. The study aimed to assess the occurrence of pharmacist’s burnout and determine outcomes for each of its dimensions; identify potentially associated characteristics; and determine profiles and critical limits.Design and Setting: Cross-sectional observational study comprising an electronic survey addressed to Portuguese Pharmaceutical Society members.Participants: From a total of 1362 participants, 91.4% were involved in direct and 7.7 % in non-direct patient care activity.Outcome measures: The statistical analysis, performed with 2-tailed significance set at PResults: Concern for the future (77.2.5%), workload (72.7%), scarcity of resources (62.4%), and loss of control over the activity (54.6%) were the main influencing factors on work-related feelings. Pharmacists who had been trained in COVID-19 were the most confident and showed a higher efficacy/outcome rate. Workload appears only as a predictor of high EE, with great impact on those who worked during the 3-month period more than 50 hours per week and on those who worked almost every weekend. The latter with greater predictive power of high EE (p≤0,001).Conclusions: The new profile-based approach provides an understanding of the burnout experience and distinct relationships with various work-life factors and suggests that each profile reflects a different work-life crisis that would require a unique intervention strategy. Pharmacists who have been involved in direct care activities are at the highest risk of burnout. However, they were able to avoid depersonalisation and cynicism and thereby burnout syndrome.Funding Information: This work was supported by the Portuguese Pharmaceutical Society. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Declaration of Interests: None.Ethics Approval Statement: The institutional review board of the of the Portuguese Pharmaceutical Society approved the project as exempt and without ethical reservations to its resolution, since (i) the procedures concerning the anonymity of the data and the information provided to the volunteers are foreseen and (ii) the nature of the elements to be collected does not carry the risk of revealing weaknesses unknown to the volunteer and thus triggering unpredictable reactions. Selecting the electronic link served as first consent to participate voluntarily in the study.

The gendered pay gap in genetic counseling.

A gendered pay gap in the genetic counseling profession has been identified in recent years, though reasons for its existence have not been explored in depth. The primary aim of this study was to determine what demographic characteristics and career experiences influence annual salary rates and which of those factors differ between male and female genetic counselors. The secondary aim of this study was to determine whether genetic counselors perceive a pay gap and to identify attitudes toward their salaries. Surveys were sent to the nearly 4,000 genetic counselors who are members of the National Society of Genetic Counselors (NSGC), and we report results from 355 respondents. A significant interaction was found between gender and position (direct vs. non-direct patient care). In the best-fitting multiple regression model, male genetic counselors earned $23,736 more than females in non-direct patient care roles (p<.001) and $1,552 more than females in direct patient care roles (p<.001). Years of experience, leadership experience score, negotiation attempts, licensure, and certification were all found to be predictors of annual salary. Most female genetic counselors perceived there to be a pay gap and most male genetic counselors did not (p=.01). Results from this study could contribute to changes in employment and compensation practices, as well as impact genetic counselors' strategies in role- and salary-based conversations.

Implementation of the Fetal Monitor Safety Nurse Role: Lessons Learned.

The fetal monitor safety nurse role was created as a supplemental support for nurses assessing fetal heart rate tracings in response to an adverse event. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. The purpose of this project was to evaluate the views of nurses who served as fetal monitor safety nurses about various aspects of the role. Nurses who served as fetal monitor safety nurses were invited to attend a small group session where they completed a survey about the role and then received information on the importance of fetal monitoring safety. Two weeks later, they were asked to take the survey again to evaluate potential changes in viewpoints. Thirty nurses attended small group sessions and completed the survey. Of those, 22 nurses completed the post survey 2 weeks later. There was minimal change in nurses' views of the fetal monitor safety nurse role after attending the small group sessions. Nurses expressed comfort in notifying peers about concerns related to the fetal heart rate tracing and perceived overall safety benefits; however, they felt that safe staffing measures were not in place to support the role. Concerns were expressed about a nurse being in a nondirect patient care position during times of high census and acuity. The fetal monitoring safety nurse may be an innovative potential solution to minimize risk of adverse events during labor that are related to accurate assessment of electronic fetal monitoring data and timely and appropriate interventions. More data are needed on improvements in fetal outcomes and adverse events potentially related to the fetal monitor safety nurse role. Budgetary support and adequate nurse staffing are required to make the role operationally feasible and safe. Valuing and seeking nurses' input as bedside experts about perinatal safety initiatives should be a part of implementing new practices.

The perceived effectiveness of MERS-CoV educational programs and knowledge transfer among primary healthcare workers: a cross-sectional survey

BackgroundKnowledge transfer of Middle East respiratory syndrome coronavirus (MERS-CoV) involves the dissemination of created/acquired information on MERS-CoV in hospitals, making this information accessible to all healthcare workers (HCWs). This study evaluated the perceived effectiveness of MERS-CoV educational programs and knowledge transfer among primary care HCWs at a hospital in Saudi Arabia that witnessed the largest outbreak of confirmed MERS-CoV cases in this country.MethodsA survey was distributed among primary care HCWs at five clinics in Saudi Arabia in 2016. Those with non-direct patient care responsibilities were excluded. Their knowledge was evaluated against facts published by Mayo Clinic Foundation, and its percentage mean score (PMS) ± standard deviation was calculated. HCWs’ perceived effectiveness of educational programs and knowledge transfer was classified as negative or positive.ResultsSample comprised of 404 HCWs, of which 64% were females and 36% were males. Almost 26% were ≤ 30 years old, and 42% had > 10 years of work experience. Almost 46.5% were nurses, 23.0% physicians, 18.1% were pharmacists, and 12.4% were technical staff. PMS for knowledge was 71.1 ± 19.4. The prevalence of negative perceptions towards educational programs was 22.5% and of knowledge transfer was 20.8%. Older(> 40 years of age) and more experienced(> 10 years) HCWs had the highest PMS for knowledge(73.4 ± 18.9,P = 0.005 and 76.9 ± 15.7,P < 0.001 respectively). Negative perceptions of educational programs (49.4 ± 20.7; P < 0.001) and knowledge transfer (46.0 ± 19.7; P = 0.001) were associated with a lower knowledge PMS. Males were 2.4[95% confidence interval 1.4–4.2] times and 2.0[1.1–3.5] times more likely to have negative perceptions of educational programs and knowledge transfer (adjusted (adj.)P = 0.001 and adj. P = 0.023, respectively). Physicians/pharmacists were 1.8[1.03–3.11] and 2.8[1.6–5.0] times more likely to have negative perceptions of both outcomes (adj. P = 0.038 and adj. P = 0.001, respectively). Less experienced HCWs were 2.1[1.3–3.5] times and 4.9[2.6–9.2] times more likely to exhibit negative perceptions of the two outcomes (adj. P < 0.001 each).ConclusionsA negative perception of the effectiveness of MERS-CoV knowledge transfer was associated with poorer knowledge and was more prevalent among male HCWs, physicians/pharmacists and less experienced HCWs. Hospitals should always refer to efficient knowledge sharing and educational strategies that render beneficial outcomes to patients, HCWs, and the public community.

Rural and Remote Continuing Nursing Education: An Integrative Literature Review

Background: Rural and remote nursing has unique practice requirements that create a need for distinct education and practice preparation. Preparing registered nurses (RNs) to work in rural and remote communities is essential for the support and advancement of rural and remote health, as there is a shortage of rural and remote health care providers. Purpose: An integrative literature review was conducted to identify the current continuing education needs of rural and remote RNs internationally. Sample: Eight studies were included in the integrative review of the literature. Countries reported in the literature included Canada (n = 2), Australia (n = 2), Sweden (n = 1) and the United States (n = 3). Method: An integrative literature review on rural and remote nursing practice continuing education was conducted using Torraco’s (2005) guidelines, in addition to Whittemore and Knafl’s (2005) methodological strategies. A search strategy was created, tested, and approved by the research team.Themes were extracted, collated, analyzed, and knowledge synthesized. Findings: Rural and remote RNs identified areas requiring enhanced ongoing training. The identified training areas were summarized into the following four themes: 1) Comprehensive specialized nursing practice for direct patient care, 2) Unanticipated events, 3) Non-direct patient care, and 4) Advanced specialty courses. Conclusion: The autonomy, competency, and expertise that is expected of RNs working in rural and remote locations requires educational supports. Rural and remote nursing continuing education is required in the areas of: comprehensive specialized nursing practice for direct patient care, unanticipated events, non-direct patient care, and advanced specialty courses. Keywords: continuing education, integrative review, registered nurse(s), remote, rural Acknowledgements: The authors thank Saskatchewan Polytechnic for partial funding of this review through the Seed Applied Research Program. The authors also thank their research team member Chau Ha and research assistant Devendrakumar Kanani for their contributions to this integrative review.

Relieving the Bottleneck: An Investigation of Barriers to Expansion of Supervision Networks at Genetic Counseling Training Programs.

Rapid growth in the demand for genetic counselors has led to a workforce shortage. There is a prevailing assumption that the number of training slots for genetic counseling students is linked to the availability of clinical supervisors. This study aimed to determine and compare barriers to expansion of supervision networks at genetic counseling training programs as perceived by supervisors, non-supervisors, and Program Directors. Genetic counselors were recruited via National Society of Genetic Counselors e-blast; Program Directors received personal emails. Online surveys were completed by 216 supervisors, 98 non-supervisors, and 23 Program Directors. Respondents rated impact of 35 barriers; comparisons were made using Kruskal-Wallis and Wilcoxon ranked sum tests. Half of supervisors (51%) indicated willingness to increase supervision. All non-supervisors were willing to supervise. However, all agreed that being too busy impacted ability to supervise, highlighted by supervisors' most impactful barriers: lack of time, other responsibilities, intensive nature of supervision, desire for breaks, and unfilled positions. Non-supervisors noted unique barriers: distance, institutional barriers, and non-clinical roles. Program Directors' perceptions were congruent with those of genetic counselors with three exceptions they rated as impactful: lack of money, prefer not to supervise, and never been asked. In order to expand supervision networks and provide comprehensive student experiences, the profession must examine service delivery models to increase workplace efficiency, reconsider the supervision paradigm, and redefine what constitutes a countable case or place value on non-direct patient care experiences.

Dynamic Interplay of Pharmacy Learners During a Solid Organ Transplantation Learning Experience

Institutions with established clinical pharmacy services have the ability to offer focused patient care learning experiences, often led by a clinical specialist, for pharmacy residents and pharmacy students. Since all parties are continually involved in professional development and lifelong learning, the aforementioned groups can all be considered “pharmacy learners.” By utilizing the dynamic interplay and collaboration between pharmacy learners through direct and nondirect patient care activities, experiential and educational opportunities may be improved and enhanced for each learner. A tiered learning approach engages individuals in areas such as direct patient care, patient education, presentations, research projects, career development, and the feedback process. We describe our experience during a solid organ transplantation learning experience using a layered learning practice model that included a clinical pharmacy specialist, a postgraduate year 2 specialty pharmacy resident, a postgraduate year 1 pharmacy resident, and a pharmacy student.

Non-direct patient care factors influencing nursing workload: a review of the literature

The aim of this paper was to detect which non-direct patient care factors are related to nursing workload in acute hospital nursing care and to develop a conceptual model to describe the relationship between the non-direct patient care factors and nursing workload. Since the 1930s, efforts to measure nursing workload have been undertaken. Still, it remains unclear which of the non-direct patient care elements are essential to the nursing workload. PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature, Engineering Village 2, Elin and the British Nursing Index were searched from 1970 up to July 2009. Studies were included in this integrative review if they described factors that are related to nursing workload or if they presented models that explored the association between potential factors, excluding the factors related to direct patient care. Thirty publications were included. The influencing variables were classified in five categories based on their level of impact: the hospital and ward, nursing team, individual nurse, patient and family and meta-characteristics. The variables were also classified, based on their cause-effect relationship. Some factors have a direct impact on the patient-nurse relationship, while others have an effect on the work fluency or on the subjective perception of the nursing workload. A conceptual model was built, based on the interaction between both classifications and derived from the systems theory. Nursing workload has a multi-causal aetiology. The influencing factors from this review can be integrated in a workload measurement tool.

Can ASHA Members Use E/M Codes?

Can ASHA Members Use E/M Codes?

The Productivity of Washington Stateʼs Obstetrician–Gynecologist Workforce: Does Gender Make a Difference?

To compare the practice productivity of female and male obstetrician-gynecologists in Washington State. The primary data collection tool was a practice survey that accompanied each licensed practitioner's license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births. Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P < or =.01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P < or =.05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P <.01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group. Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States. II-3

From past paradigms to future frontiers: unique care delivery models to facilitate nursing work and quality outcomes.

As healthcare processes were reengineered in response to managed care, traditional care delivery models were abandoned, resulting in nursing staff dissatisfaction, increased healthcare error, and eroding clinical outcomes. An aging patient population, chronicity of illness, the proliferation of new medical information and technology, severity of illness, and the focus of acute care to "stabilization and transition" necessitate the creation of systems that address changes in nursing work expectations while maximizing available resources. By evaluating unit-specific structure and process criteria and allocation of provider roles, unique, setting-specific care delivery models can be created to facilitate direct and nondirect patient care functions, resulting in improved financial and clinical outcomes.

Making a difference?

Making a difference?