Staffing Patterns Research Articles

Towards a conceptual framework for the relationship between subsidiary staffing strategy and subsidiary performance

Staffing key management positions at host country subsidiaries is a strategic challenge for most MNEs. While previous research in this domain explored the antecedents of MNE subsidiary staffing decisions, strategic outcomes of different staffing patterns (e.g., using parent, host, or home country nationals) have been mostly overlooked. Drawing from the resource-based view of the firm, we develop a theoretical model that explains the links between different strategies for staffing key management positions in host country subsidiaries and the performance of those subsidiaries in their host markets and within their MNE networks. Further, we propose contingencies that moderate the relationship between subsidiary staffing strategy and host country and MNE network performance.

Obesity, Bariatric Nursing, and the Policy Process: The Connecting Points for Patient Advocacy

Abstract Obesity has become a global public health issue with increasing prevalence rates reaching pandemic proportions. Opportunities exist for nursing involvement in policy issues including but not limited to safe staffing patterns, safe handling of bariatric patients, national standards for food and beverages sold in schools, and insurance policies for obesity. Nurses are well suited to apply their expertise and influence in the policy process. The policy process is a dynamic, nonlinear process that includes agenda setting, legislation, regulation, implementation, and ongoing evaluation involving formal and informal relationships with special interest groups, individuals, legislators, bureaucrats, and/or political parties. A clear understanding of the entire policy process is imperative to successful participation in the policy arena. Nurses have a professional obligation to advocate for clients through participation in the policy process. Participation in the policy process influences the direction of...

Pandemic Influenza: Impact on Perianesthesia Nursing Areas

As our readers are aware, these pages are typically used by the editors. However, in light of the recent events and concerns surrounding the swine flu, the editors have elected to quickly substitute an informative piece regarding influenza for the usual editorial. We thank Dr. Daphne Stannard for her willingness to disseminate her knowledge on the topic. The Editors

Does community management of COPD exacerbations really prevent hospital admission?

The Centers for Disease Control and Prevention is partnering with the National Association of Chronic Disease Directors and the North Carolina Office of EMS to design, develop, and implement an emergency medical services (EMS) performance improvement toolkit to evaluate opportunities to improve the emergency identification and treatment of acute stroke. The EMS Acute Stroke Care Toolkit is being developed, tested, and implemented in all 100 counties in the state by the EMS Performance Improvement Center, the agency that provides technical assistance for EMS in North Carolina. The toolkit helps each EMS system in defining, measuring, and analyzing their system of care and promotes collaboration through public education, regional stroke planning with hospitals, EMS service configuration, EMS staffing patterns, EMS education, and timely care delivery. We outline the issues surrounding acute stroke care, the role of emergency medical systems in stroke care, and the components of the EMS Acute Stroke Care Toolkit designed to improve EMS systems and outcomes for stroke patients.

The 40th Anniversary of Primary Nursing: Setting the Record Straight

Since its development in the 1960s, primary nursing has become the model of care delivery in many health care settings. Over time, myths have developed about primary nursing's relevance in environments with high acuity, varying skill mixes, diverse staffing patterns, and short lengths of stay. This article addresses those myths.

Single Specialty Hospitals and Nurse Staffing Patterns

Advocates of physician-owned single specialty hospitals (SSHs) maintain that, through healthy competition, SSHs pressure competitor hospitals in local markets to improve performance. This paper investigates data trends on the effects of SSH entry on a potential indicator of quality of care in general hospital competitors: nurse staffing levels. We examined registered nurse (RN) staffing from 1997 to 2004 in ten states in which there was considerable SSH entry during this period. Regression estimates used longitudinal panel data models with hospital fixed effects to compare changes in numbers of RNs in general hospitals located in markets with SSHs with general hospitals located in markets where there were no SSHs. Results indicate that hospitals located in markets with orthopedic/surgical SSH presence raised their RN nurse staffing levels. Whether or not these changes are associated with improved patient outcomes is unknown.

In-Home Chronic Disease Management in Diabetes

With the rate of diabetes increasing in the elderly, home health care agencies must creatively approach disease management in this high-risk population. Specialized training programs, standardized policies and procedures, and strategic staffing patterns support agencies to systematically and effectively manage diabetes in the home. Collaboration with endocrinology providers assists agencies to incorporate and appropriately use national standards in diabetes care. Additionally, home health partnership with endocrinology providers will enhance a disease management program with increased provider participation and oversight, improving patient clinical outcomes and serving as a resource for home health agencies managing patients with diabetes.

Revolution at the Library Service Desk

ABSTRACT This article will describe how a revolution in customer service provision beginning in 2002 has led to an evolution of library services. When the reference and circulation desks were merged to create a single service point, responsibilities were broadened, core competencies were developed, and staff members were cross trained. In 2005, an analysis of staffing and work patterns demonstrated a need to build upon the original model to better utilize staff and ensure coverage of the desk. Reference librarians were moved to “on call” status, technical services staff were added to the schedule, and core competencies and procedures were refined.

Nursing and transplant coordination: a call for clarity

Organ transplantation is a complex and highly regulated field. This review focuses on the role of nurses and transplant coordinators in solid organ transplantation, excluding both inpatient staff nursing and procurement activities. The literature describes a robust and autonomous transplant coordinator role; a key member of the multidisciplinary transplant team. Transplant coordinators facilitate patient care throughout all phases of transplantation. However, a lack of consensus on licensure and educational preparation of these important practitioners was evident from the review of literature. Synthesis of the data suggests that the role of transplant coordinator is not distinct but a description of a wide variety of functions, duties, and tasks that require varying levels of licensure and educational preparation. Greater clarity for both practitioners and consumers could be achieved by creating certification levels similar to nephrology nurses. As no transplant-specific staffing models or benchmarks were discovered, rigorous research regarding optimal staffing patterns is also recommended.

Nursing and Transplant Coordination: A Call for Clarity

Organ transplantation is a complex and highly regulated field. This review focuses on the role of nurses and transplant coordinators in solid organ transplantation, excluding both inpatient staff nursing and procurement activities. The literature describes a robust and autonomous transplant coordinator role; a key member of the multidisciplinary transplant team. Transplant coordinators facilitate patient care throughout all phases of transplantation. However, a lack of consensus on licensure and educational preparation of these important practitioners was evident from the review of literature. Synthesis of the data suggests that the role of transplant coordinator is not distinct but a description of a wide variety of functions, duties, and tasks that require varying levels of licensure and educational preparation. Greater clarity for both practitioners and consumers could be achieved by creating certification levels similar to nephrology nurses. As no transplant-specific staffing models or benchmarks were discovered, rigorous research regarding optimal staffing patterns is also recommended.

Unmet Symptom Management Needs of Nursing Home Residents With Cancer

Nursing home residents living with cancer have unacceptably high percentages of unrelieved pain and other symptoms. However, residents with cancer have received relatively little attention in the literature to date. This article provides an overview of previous symptom research for residents with cancer, explores clinical and organizational factors that impede effective symptom management, and proposes an agenda for future research and clinical practice. Residents with cancer have numerous symptoms that tend to be different from the symptoms of other nursing home residents. Symptom management for residents with cancer is often complicated by cognitive impairment, declining physical functioning, and comorbid illnesses. Barriers to symptom management include underuse of analgesics and hospice, nursing home staffing patterns, and lack of resources. Additional research is necessary to provide a more comprehensive understanding of residents with cancer, explore how organizational factors affect the care of residents with cancer, and evaluate interventions for effective symptom assessment and management. Collaboration of oncology nurses with clinicians and researchers in nursing home settings is needed to improve care for residents with cancer.

The Effect of Nurse Staffing Patterns on Medical Errors and Nurse Burnout

Hospital administrators frequently rely on the use of mandatory or voluntary overtime to cover staff nurse vacancies. This practice is common in the perioperative setting, but it can lead to staff-member fatigue that may adversely affect patient safety. This literature review explores the effect that nurse staffing patterns have on the frequency of medical errors, fatigue, and nurse burnout. The evidence indicates that inadequate nurse staffing leads to adverse patient outcomes and increased nurse burnout. Hospital administrators should invest in adequate nurse staffing to improve patient safety and increase nurse retention.

Revolving Doors?

This article analyzes the movement of personnel among elite positions in business and government, contrasting the staffing patterns at higher rungs of the executive branch during the Clinton and G. W. Bush administrations. We find that the Bush administration recruited far more heavily from among corporate officers and directors than did the Clinton administration, particularly when staffing ambassadorships. We also find that both administrations served as springboards for subsequent corporate board appointments. There were relatively few patterns with respect to industry or geography, with the exception of the military: All but one of the Joint Chiefs of Staff at the turn of the millennium ended up serving on the board of a military contractor after completing their government service.

98: Declining Resident Productivity Over Time in the Emergency Department

It has been established in the Emergency Medicine (EM) literature that residents are able to evaluate more patients per hour (productivity) as they progress through training. Whether resident productivity varies as a function of accumulated time in the emergency department during the course of a given shift has not been assessed. This information is important, as it can be used to better understand residents’ contribution to patient flow in an emergency department (ED), and can help delineate optimal staffing patterns to assist with patient flow.

The Long Road Home: Rebuilding Public Inpatient Psychiatric Services in Post-Katrina New Orleans

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.

Alarms and Nurse to Patient Ratios

As much as I enjoyed the technical aspects of the article by Korniewicz and colleagues,1 it did seem to beg the question, “Who’s even there to hear the alarm?” An adequate alarm system does not make up for the inadequate staffing patterns that are so prevalent in intensive care units across the United States.The article mentioned the 23 injury and death reports associated with mechanical ventilation. Why isn’t a patient who is dependent on a ventilator assigned one nurse to care for him or her, as is the case in England? Wouldn’t we be better patient advocates if we argued for safe staffing instead of better alarms?

Managing the complexity of nurse shortages: A case study of bank and agency staffing in an acute care Trust in Wales, UK

BackgroundManaging nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare. ObjectiveTo analyse bank and agency nursing staffing patterns and factors that impact on these patterns. Design and settingCase study within the largest hospital in one Welsh Integrated Healthcare Trust. Data sourcesDe-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff. ResultsA predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training. ConclusionThere is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff.

Expert ratings on the critical ingredients of supported employment for people with severe mental illness.

Supported employment is identified as an evidence-based practice for people with severe mental illness, with Individual Placement and Support (IPS) emerging as the clearest articulation of this practice. Yet throughout the U.S., programs labeled as supported employment operate in a wide variety of ways, with different staffing patterns, organizational features, and services. Consensus on critical ingredients is crucial for establishing standards for evidence-based services, guiding implementation of new programs, and fostering communication in the literature. The current study examined the degree of agreement on the critical ingredients of supported employment among experts and practitioners. The expert sample (n=19) consisted primarily of university-based researchers, while the practitioner sample (n=55) was a convenience sample generated from lists provided by state leaders in 2 Western, 2 Central, and 2 Eastern states. Using multiple sources, including published guidelines and 3 supported employment fidelity scales, we developed a 59-item survey checklist. Respondents rated items on a 7-point importance scale and indicated ideal specifications in 11 areas. We found strong agreement on the critical ingredients of supported employment within the expert and practitioner groups. On most items, the two groups had similar mean ratings of importance. Experts rated 4 items reflecting evidence-based principles and 2 items related to outcome monitoring as more important than did practitioners, while practitioners rated as more important 10 items reflecting pragmatic concerns (e.g., funding, accreditation). Comparing survey responses on the 15 items from the IPS Fidelity Scale suggested general endorsement of IPS principles, except in the area of staffing. Ideal model specifications included caseload size of 16 and twice weekly supervision. Respondents also suggested critical ingredients not measured by the IPS Fidelity Scale, such as benefits counseling, supported education, a cultivation of employers. This survey shows a growing consensus within the psychiatric rehabilitation field on IPS principles while suggesting additional strategies endorsed by experts and practitioners.

The Impact of Policy on Nursing and Allied Health Services: Lessons from the Medicare Home Health Benefit

This article analyzes changes in Medicare home health staffing and service delivery patterns across three different reimbursement methods: cost based (1996), interim payment system (IPS) (1999), and the prospective payment system (PPS) (2002). This study combined secondary analysis of existing data (Provider of Services File and Statistical Supplement) with qualitative interviews of 22 home health agency directors to understand agency responses to policy changes created under the Balanced Budget Act of 1997. Cuts in staff and visits were greater under the IPS than they were under the PPS. Agencies cut staff and visits more dramatically for nonskilled services across both time periods. As a proportion of total services and visits, nursing and therapy services increased the most. Directors used various strategies to sustain the agency financially during these dramatic cuts in reimbursements, including eliminating staff, shifting staff roles, training staff on reimbursement methods, increasing use of telephone monitoring, increasing patient and family education and self-care, and cutting services to patients. Directors expressed concerns about staff stress related to the changes and the need to increase productivity without increasing staff. However, directors also believed the agency's position would improve under the PPS. Additional research is needed to determine whether increased staff stress, work demands, and fewer resources for patients will affect the quality of care delivered and, thus, patient outcomes under the PPS.

Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location

The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff.