Staff Mix Research Articles

Primary care services co-located with Emergency Departments across a UK region: early views on their development

BackgroundCo-location of primary care services with Emergency Departments (ED) is one initiative aiming to reduce the burden on EDs of patients attending with non-urgent problems. However, the extent to which...

Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis.

To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theoremin Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed.

Developing a caseload classification tool for community nursing.

Acuity and dependency in the community nursing caseload in combination with safe staffing levels are a national issue of concern. Current evidence suggests that there are no clear approaches to determining staff capacity and skill mix in these community settings. As community nursing caseloads are large with differing complexities, there is a need to allocate community nursing with the best skill mix to achieve the best patient outcomes. A city-wide service improvement initiative developed a tool to classify and categorise patient demand and this was linked to an electronic patient record system. The aim was to formulate an effective management response to different levels of acuity and dependency within community nursing teams and a consensus approach was used to allow the definition of complexity for twelve packages of care. The tool was piloted by a group of community nurses to assess the validity as a method to achieve a caseload classification. Seventy nurses were trained and applied the tool to 3000 patient referrals. Based on this, standards of care were agreed including expectations of assessment, intervention, visit length and frequency. Community nursing caseloads can now be organised according to acuity and complexity of patient need, which determines allocation of staff and skill mix.

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

Objective: With increasing demands to provide a cost efficient nursing service, changes to nursing skill mix are being implemented globally. Team nursing as a model of care is seen as a way to address both patient care and safety issues. The aim of this study was to explore job satisfaction (JS) and stress outcomes of nursing staff when introducing team nursing as model of care within the Australian healthcare environment.Methods: An experimental study was utilised. Nursing staff (n = 63) were surveyed, using the Person Centred Nursing Index (PCNI) tool, prior to the implementation of a team nursing model of care and then again six months post implementation of the model (n = 64). Data was analysed to determine if there was a statistically significant difference in the average theme between pre and post surveys.Results: Nursing stress (NS) was reduced and JS was increased post implementation of the new model of care. JS and organisational traits, JS and work stress (WS), were positively related and increased post implementation. WS and nursing care (NC), organisational traits and NC were positively related but showed no statistically significant change after the implementation. This study demonstrated that in introducing a new model of care, levels of stress staff increased yet unexpectedly JS also improved.Conclusions: Decisions to adopt team nursing as the model of care should be based on a broad range of considerations not simply on fiscal considerations and should include staff readiness, staff mix and supportive measures to introduce a changed model of care.

The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers

To assess how medical staffing mix changed over time in association with the adoption of electronic health records (EHRs) in community health centers (CHCs). Community health centers within the 50 states and Washington, DC. Estimated how the change in the share of total medical staff full-time equivalents (FTE) by provider category between 2007 and 2013 was associated with EHR adoption using fractional multinomial logit. 2007-2013 Uniform Data System, an administrative data set of Section330 federal grant recipients; and Readiness for Meaningful Use and HIT and Patient Centered Medical Home Recognition Survey responses collected from Section330 recipients between December 2010 and February 2011. Having an EHR system did significantly shift the share of workers over time between physicians and each of the other categories of health care workers. While an EHR system significantly shifted the share of physician and other medical staff, this effect did not significantly vary over time. CHCs with EHRs by the end of the study period had a relatively greater proportion of other medical staff compared to the proportion of physicians. Electronic health records appeared to influence staffing allocation in CHCs such that other medical staff may be used to support adoption of EHRs as well as be leveraged as an important care provider.

Variability of staffing and staff mix across acute care units in Alberta, Canada.

BackgroundThe health workforce has a crucial position in healthcare, and effective distribution of the workforce is one of the critical areas for healthcare improvement. This requires a proper understanding of the allocation of healthcare providers including staffing levels and staffing variability within a healthcare system. High variability may imply significant differences in outcomes and greater opportunity to better distribute staffing and improve patient outcomes. The objective of this study was to examine staffing variation across acute care units in a large and integrated healthcare system.MethodsWe used survey and administrative data on full time equivalencies of Registered Nurses, Licensed Practical Nurses, Health Care Aides, and allied health staff for 287 acute care units to examine staffing levels across multiple unit types. We used a subsample of 157 units in a more detailed analysis of staffing levels and staff distribution.ResultsResults from the full sample indicate that staffing levels, particularly for Registered Nurses, vary substantially across unit types. Subsample analyses showed that the highest variation in staffing levels occurred in rural units, which also had higher average staffing for licensed practical nurses and allied health staff. Rural units had fewer Health Care Aides than did other units. The majority of units were staffed with a combination of all three nursing providers, but the most common arrangement in rural units was staffing of Registered Nurses and Licensed Practical Nurses only. We also found that units with the highest number Registered Nurses also tended to have higher numbers of other staff, particularly allied health providers.ConclusionsWe observed significant variation in staffing levels and mix in acute care units. Some of the differences might be attributable to differences in patient needs and unit types. However, we also observed high variability in units with similar services and patient populations. As other research has shown that staffing is linked to differences in patient outcomes, there is an important opportunity to improve staffing for greater efficiency and higher quality care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-016-0172-1) contains supplementary material, which is available to authorized users.

Delegation in Correctional Nursing Practice.

Correctional nurses face daily challenges as a result of their work environment. Common challenges include availability of resources for appropriate care delivery, negotiating with custody staff for access to patients, adherence to scope of practice standards, and working with a varied staffing mix. Professional correctional nurses must consider the educational backgrounds and competency of other nurses and assistive personnel in planning for care delivery. Budgetary constraints and varied staff preparation can be a challenge for the professional nurse. Adequate care planning requires understanding the educational level and competency of licensed and unlicensed staff. Delegation is the process of assessing patient needs and transferring responsibility for care to appropriately educated and competent staff. Correctional nurses can benefit from increased knowledge about delegation.

Medical readiness: evaluating the robustness of medical clinic staffing solutions

Medical readiness requires Department of Defense medical clinics to be robust to changes in patient demand. Minor fluctuations in patient demand occur on a regular basis, but major increases can also occur. Major demand increases can result from a number of occurrences, including mass military deployments, medical incidents, outbreaks, and overflow from Veterans’ Affairs clinics. This research evaluates a system of clinics at Wright-Patterson Air Force Base in order to determine its ability to handle a 200% surge in patient demand. In addition, this study evaluates the relative effectiveness of six different staffing mix options to minimize patient wait times, also under the surge demand conditions. This evaluation is conducted using discrete-event simulation to estimate patient wait times and includes a sensitivity analysis of the increased patient demand, as well as a cost–benefit analysis to determine the most cost-effective alternative scenario. The study finds that adjustments to staffing mix enable cost savings while meeting current demands. In addition, the study finds that adjusting the staffing mix will not have a negative impact on patient wait time in the surge conditions, relative to the current staffing mix.

Skilled Birth Attendance Rates in Burkina Faso Rose After Debut of Policy Subsidizing User Fees

After the 2007 introduction of a policy to subsidize maternal health user fees in Burkina Faso, the rate of skilled birth attendance increased among women across all socioeconomic status strata. According to a quasi-experimental study conducted in 2008-2010, the increase was sustained for two years and was most pronounced among the poorest women. (1) For example, among women in the lowest socioeconomic stratum, the rate of skilled birth attendance was an estimated 45% higher immediately after program implementation than it would have been had the subsidy policy not been introduced (rate ratio, 1.5); the rates 6-24 months after implementation were an estimated 46-48% higher than they would have been in the absence of the subsidy (1.5 each). Among women in the highest socioeconomic stratum, the rates of skilled birth attendance were an estimated 19-21% higher 0-24 months after program implementation (1.2 each). In 2007, in an effort to promote facility-based skilled birth attendance, the government of Burkina Faso began to subsidize 80-100% of the direct costs related to delivering in a health facility. Given, however, that the literature on the effects of such subsidies is both limited and contradictory, researchers sought to examine the effects of user-fee subsidies on skilled birth attendance across socioeconomic strata. For their study, they used data from two population-based surveys conducted in the Hounde and Ziniare health districts in 2008 and 2010, and from a 2010 survey of the 27 primary health centers in the study area. Women were eligible for the population surveys if they were aged 15-49 and had given birth in the previous five years for the 2008 survey or in the previous two years for the 2010 survey; the period of observation covered 50 months before the introduction of the subsidy through 41 months postintroduction. In all, 1,408 women participated in the 2008 survey and 1,403 participated in 2010; 74% of all women participated in both. The population surveys collected data on the social, demographic and economic characteristics of the women and their households, their health-seeking behavior during pregnancy and delivery, and the timing and conditions of delivery. The facilities survey assessed the quality of care at the primary health centers in the study area by examining their number and mix of staff, medical equipment and infrastructures, including access to water. The researchers calculated descriptive statistics for the women, and used modified Poisson regression analyses to determine the rate ratios and rate differences for the associations between the introduction of the subsidy and skilled birth attendance over time, across socioeconomic status. Also, they estimated expected rates of skilled birth attendance for 2007 and beyond under the counterfactual scenario of no subsidy introduction to enable causal interpretation of the estimated rate changes. …

Comment on ‘Building allied health workforce capacity: a strategic approach to workforce innovation'

Somerville et al.1 discuss the importance of using allied health assistants (AHAs) and building on the current allied health workforce to ensure the long-term sustainability of the appropriate skill mix of staff employed within healthcare.2 This reinforces that the quality of care provided to patients needs to be provided by the right person, with the right skills, experience and clinical expertise, at the right time.Somerville et al.1 found that between 11% and 17% of tasks completed by allied health professionals (AHPs) could be delegated to, and within the scope of practice of, AHAs with appropriate supervision provided by an AHP. Clinical tasks represented the majority of the workload that could be reallocated to an AHA, with 55.5% of AHPs reporting that certain tasks within their current workload could be completed by AHAs. The impact of this has associated cost-benefits, as well as improving overall patient experience and outcomes,3 and has implications for the job satisfaction of AHPs.4The 11%-17% of tasks that could be reallocated to AHAs is crucial because AHPs have more recently been seen to be undertaking advanced scope of practice roles5,6 in a range of clinical settings. Theseroleshave been seento providesignificant efficiencies, such as reducing patient waiting times, improving patient flow and access to services and improving the quality of patient care.3,7 By allocating up to 17% of a workload to AHAs, this would further support AHPs in using their clinical expertise and skills to complete high-level tasks.Queensland Health have piloted an Advanced Clinical Practice Framework,8 and the associated benefits of this framework include improving access to services, improved service delivery, increasing workforce productivity, enhancing patient experience and addressing compliance with national priorities.In order to support AHPs pursuing and transitioning into roles such as these, we need to create workload capacity for them; this can be achieved through further investment and better utilisation of the AHA model of care.The challenge we currently have is that AHPs need to provide adequate supervision and training to AHAs to ensure they maintain an acceptable level of competence and be proficient in the skill of delegation. The ability of AHPs to achieve this in an economic climate where public sector funding is being reduced, the demand for hospital access remains high and allied health services are being rationalised makes this increasingly difficult. …

Adding to the staff mix

Adding to the staff mix

Measuring patient dependency in the emergency department

The Jones Dependency Tool can be used in emergency departments to improve patient care and identify the required staffing and skill mix. Using the tool, the nurse can accurately identify a patient's specific nursing needs. The dependency tool is used to evaluate patients' needs in six areas: communication; airway, breathing and circulation; mobility; eating, drinking, elimination and personal care; environmental safety, health and social needs; and triage. Appropriate nursing care can be tailored to the dependency level, depending on whether the dependency level is low, moderate, high or total dependency.

Medication Assistant-Certification Program in Washington State: Barriers to implementation

Medication assistants (MAs) are a legal alternative that enables licensed nurses to safely delegate medication administration to stable residents in non-acute settings. The purpose of this study was to query the beliefs and understanding of skilled nursing facility staff regarding the Washington State Medication Assistant Endorsement Program (MAEP). A 15-item survey was developed and administered to a convenience sample of 218 nursing staff from five eastern Washington nursing homes. Most believed that MAs would not change the cost of care, nor would they enhance or reduce the quality of care provided to residents in skilled nursing facilities. The relatively few Licensed Practical Nurses surveyed (n = 19) were the least in favor of MAs, possibly fearing job loss with the addition of MAs to the staffing mix at their facilities. These factors in combination may reflect why MAEP has not yet been embraced by providers in Washington State.

Caring for acutely unwell older residents in residential aged-care facilities: Perspectives of staff and general practitioners.

To explore the challenges and facilitators of managing acutely unwell residents in their residential aged-care facilities (RACF) and transferring RACF residents to the emergency department of a tertiary referral hospital in Australia. This exploratory study used a qualitative descriptive approach incorporating structured focus group interviews with nursing staff from RACFs and General Practitioners (GPs) within the local area. Four focus groups were held with staff from RACFs and one with GPs who visited one or more of the facilities during 2010. The interview data were analysed for themes relating to the study aims. Findings revealed both challenges and facilitators associated with managing acutely unwell older people including, communication, nursing staffing mix and numbers, use of advanced care directives, responsibilities of GPs and awareness of community services. From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care.

Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study

ObjectivesTo describe care worker–reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. DesignCross-sectional study. SettingNational, randomly selected sample of Swiss nursing homes, stratified according to language region and size. ParticipantsA total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. MeasurementsCare worker–reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale–Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. ResultsOverall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36–8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08–4.15); less stress due to workload (OR 0.71, 95% CI 0.55–0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24–0.49); and less rationing of social care (OR 0.80, 95% CI 0.69–0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. ConclusionsWork environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.

Potential underreporting of medication errors in a psychiatric general hospital in Japan.

The purpose of this study was to explore a pattern of underreporting within a psychiatric general hospital in Japan. All the medication errors reported online in 2010 were analysed. This research was approved by the university and the study hospital. There were 651 incidents related to medication errors. Medication error rate per 1000 patient days was 2.14 (range: 0.45-6.05). Medication error rates between two acute care wards with comparable case and staff mix differed. A low proportion of intercepted near-misses and low medication error rates around mealtime in acute care 1 were suggestive of under-reporting. Two dementia care wards with low medication error rates had no report of intercepted errors, which was also suggestive of underreporting. Ward-specific medication error rates and patterns are useful to identify wards with potential underreporting of medication error within the hospital.

"Planning eye health services in Varamin district, Iran: a cross-sectional study".

BackgroundA recent survey of avoidable blindness in Varamin District, Iran, identified moderately high levels of visual impairment (10%) and blindness (1.5%) in people >50 years. This study aimed to define current provision, identify gaps and suggest practical solutions for improving eye health services in this area.MethodsThe World Health Organization (WHO) framework for analyzing health systems has several key components: service delivery, health workforce, information system, medical products and technologies, financing, and governance. We used this structure to investigate the strengths and weaknesses of the eye health system in Varamin. All public and private eye care facilities and a random selection of primary health care (PHC) units were assessed using semi-structured researcher-administered questionnaires.ResultsVaramin has 16 ophthalmic clinics, including two secondary hospitals that provide cataract surgery. There were ten ophthalmologists (1:68,000 population), two ophthalmic nurses and five optometrists working in Varamin district. There were no eye care social or community workers, ophthalmic counsellors, low vision rehabilitation staff. Although the Vision 2020 target for ophthalmologists has been met, numbers of other eye care staff were insufficient. The majority of patients travel to Tehran for surgery. The recent survey identified cataract as the leading cause of blindness, despite the availability of surgical services in the district and high health insurance coverage. Poor awareness is a major barrier. No units had a written blindness prevention plan, formal referral pathways or sufficient eye health promotion activities. Only one of the PHC units referred people with diabetes for retinal examination. There is partial integration between eye care services and the general health system particularly for prevention of childhood blindness: chemo-prophylaxis for ophthalmia neonatorum, school vision tests, measles immunization and Vitamin A supplementation.ConclusionsThis analysis demonstrated the need for better integration between eye care services and the general health system, local planning for prevention of blindness, an information system, a better staff mix and health education to increase community awareness and service uptake. There is the capacity to deliver far more surgery locally. All aspects of a health system need to be developed to deliver comprehensive and efficient eye care.

Age Management as Contemporary Challenge to Human Resources Management in Slovak Companies

Abstract Due to demographic changes in society and the labor market in the European Union in the future there is expectation of major shortage of managers and specialists in certain professions. Therefore it will be necessary focus not only on the potential of young talents, but also categories of aging employees, which have lately been considered unpromising. Ability to retain workers in employment, to enhance sustainable performance and manage generational mix of staff requires a cultural change as well as changing practices of human resource management. It has requires to approach to managing holistically, but also individually. The solution to this problem is human resource management oriented on life phases that will provide employees throughout their working life with interesting and challenging work and therefore maintain their engagement and committed. The paper contains identification of human resources management practices and a policy oriented on life stages and analyzes the readiness of Slovak companies to meet this challenge of their application.

Care interaction adding challenges to old patients’ well-being during surgical hospital treatment

Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9) during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010). The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.

Emergency department overcrowding and long wait times: taking a corporate approach to improving patient flow.

Emergency department (ED) overcrowding and long wait times are major concerns in health systems the world over. Many ED-focused innovations--such as revising staff mix, improving internal processes and exploiting decision-support software--have been implemented to address these complex problems, often with limited success. Beginning in 2008, St. Michael's Hospital in Toronto, which had some of the most challenging ED overcrowding and longest wait times in Ontario, has charted a different course. By taking an organization-wide corporate approach to the challenge of patient flow throughout the hospital, St. Michael's has significantly improved key ED flow metrics for both its admitted and non-admitted patients.