Changes in reimbursement make it imperative for nurse managers to develop tools and methods to assist them to stay within budget. Disparity between planned staffing and required staffing often requires supplemental staffing and overtime. In addition, many states are now mandating staffing committees to demonstrate effective staff planning. This retrospective quantitative study developed an empirical method for building nursing unit staffing plans through the incorporation of patient acuity and patient turnover as adjustments towards planning nursing workload. The theoretical framework used to guide this study was structural contingency theory (SCT). Patient turnover was measured by Unit Activity Index (UAI). Patient acuity was measured using case mix index (CMI). Nursing workload was measured as hours per patient day (HPPD). The adjustment to HPPD was made through the derivation of a weight factor based on UAI and CMI. The study consisted of fourteen medical, surgical, and mixed medical-surgical units within a large academic healthcare center. Data from 3 fiscal years were used. This study found that there were significant, but generally weak correlations between UAI and CMI and HPPD. The method of deriving a weight factor for adjusting HPPD was not as important as the decision-making relative to when to adjust planned HPPD. In addition, the measure of unit activity index was simplified which will assist researchers to more easily calculate patient turnover. As a result of this study, nurse managers and will be better able to adjust and predict HPPD in cases where benchmarking has been problematic. Data-driven adjustments to HPPD based on UAI and CMI will assist the nurse manager to plan and budget resources more effectively.

D.Cur. / Please refer to full text to view abstract

M.Cur. (Nursing Management) / The largest and most expensive asset of any health care institution is its human resources. Mol [1984 : 1J quite correctly says that no organization can reach its full potential when these resources are not utilized effectively. The researcher has noticed certain behavior patterns amongst the nursing staff in intensive care units. These behaviour patterns include an increase in staff turnover and absenteeism. The question that arose was whether it could be ascribed to professional burnout and whether nursing managers could be contributing to the cause thereof. Th. burnout syndrome is a slowly developing psychologically destructive process, which is in relation to the effect the work environment· has on the individual. The consequences of professional burnout has many negative effects on the nurse, ·the patient, the profession and the health care delivery system. The concept of professional burnout is described with reference from the literature and by means·of a survey the following was determined, that:- all nurses working in intensive care units in the hospital were the research was conducted, had experienced symptoms of professional burnout; the majority of these nurses perceive their work situation as severely stressful; and - nursing managers are overwhelmingly applying the autocratic leadership style. Some of the important conclusions culminating from this study are that:- all these nurses experience one or other degree of professional burnout as a result of experiences resulting from unresolved stress in the work environment; and the nursing manager possibly uses ineffective management strategies due to a lack of management training, thus contributing to professional burnout.

No description available.

No description available.

Ballad Health nurse leaders received little nursing leadership education or competency development before beginning their leadership roles; yet they are crucial to improve quality, safety, cost, patient experience, and team member engagement. Competency development is linked to improved nurse leader confidence, job satisfaction, and retention. Additionally, the organization is experiencing a shortage of prepared internal candidates to fill vacant nurse manager positions. The organization’s Chief Nursing Council (CNC) questioned if a leadership development program could improve new and aspiring nurse managers' leadership competency. The CNC aimed to improve nurse leader competency by implementing and measuring the effectiveness of an evidence-based Nurse Leader Residency Program (NLRP) for new and aspiring nurse leaders. The CNC elected to base the NLRP on the American Organization of Nursing Leadership (AONL) Nurse Learning Domain Framework and Benner’s Novice to Expert Theory. Internal expert instructors addressed all AONL leadership topics during seven weekly in-person education sessions. Instructors provided the curriculum through lectures, group activities, individual activities, case studies, and videos. The residents assessed 105 competencies using the AONL Nurse Leader Competency Assessment Tool before and after program participation. Finally, the residents collaborated with their Chief Nursing Officer to identify a mentor. The resident group improved its overall self-assessed nursing leadership competencies by 50%. Residents’ self-competency improvement ranged between 0.5 - 2.0 on a 5-point scale. Implementing an evidence based NLRP improves new and aspiring nurse leader self-assessed competencies. Nurse leaders need advanced knowledge and competencies to successfully lead in the complex healthcare environment.

No description available.

M.Cur. (Nursing Science) / The need for improved nursing leadership. especially in the nursing service situation, within an ethnicheterogenous nursing society demands appropriate leadership development to meet the needs of dynamic health care delivery. Nursing leadership from an ethnographic perspective has not been researched in this country. Hence, the views of senior black professional nurses, within a particular research context (operating theater department), have been explored in relation to the influence of their occupational life histories on their particular views. The results have been controlled with an extensive literature review...

Emergency department (ED) crowding is a patient safety concern that has been increasing for more than a decade. Increased visits have resulted in ED crowding, longer wait times, ambulance diversions, and boarding of admitted patients (Hing & Bhuiya, 2012). Numerous factors affect ED crowding. Once various extraneous issues are resolved and a bed is available for a patient, it becomes the responsibility of nurses across unit boundaries to coordinate the patient transfer. This study applies Relational Coordination Theory (RCT) as a framework to provide nurses insight into the relational aspects of their work in the transfer of ED patients to inpatient beds. Relational coordination is a mutually reinforcing process of interaction between communication and relationships that is carried out for the purpose of task interaction. It is useful for coordinating work that is highly interdependent, uncertain, and time constrained (Gittell, 2002). Nurses work during ED transfers requires task interaction as they coordinate their efforts. This study, guided by RCT, will examine relational and communication dynamics among nurses within their own units and across unit boundaries as they interact during ED transfers. A cross-sectional, descriptive design will explore the seven dimensions of Relational Coordination (RC) during ED admissions and explain nurses relational and communication dimensions that may influence ED boarding times. The results of this study provide new information and a sound theoretical model on which to base future research.

Esta pesquisa é um estudo de caso com os objetivos de: avaliar a implementação de um protocolo de prevenção de Úlcera por Pressão (UP) por meio do estudo da Prevalência e da Incidência de UP nas unidades de Clinica Médica, Clinica Cirúrgica e Terapia Intensiva Adulto, do Hospital Universitário da Universidade de São Paulo; apreender a percepção das enfermeiras multiplicadoras no processo de implementação do protocolo e propor um processo de avaliação, sistematizado e contínuo da adoção do protocolo de UP. Após aprovação do Comitê de Ética em Pesquisa do HU, procedeu-se à coleta de dados. Optou-se, na metodologia, pelo desenvolvimento da pesquisa em dois momentos. O primeiro, na abordagem quantitativa, realizado em duas etapas, para o levantamento da prevalência e da incidência de UP nas unidades do estudo. A avaliação de risco para o desenvolvimento de UP foi feita por meio da Escala de Braden, tendo como nota de corte o escore inferior ou igual a 16. No estudo da prevalência, dos 87 pacientes avaliados, 17 desenvolveram UP, acarretando prevalência de 19,5%. No estudo da incidência, dos 190 pacientes de risco acompanhados, 35 desenvolveram um total de 51 úlceras, acarretando incidência de 18,4%. Para o segundo momento, na abordagem qualitativa, os dados foram coletados por meio das técnicas de Entrevista e Grupo Focal, realizadas com as enfermeiras que participaram, como multiplicadoras, do processo de implementação do protocolo. Adotou-se a análise de conteúdo de Bardin como referencial de análise do conteúdo das Entrevistas e do Grupo Focal. A análise interpretativa dos dados qualitativos das entrevistas possibilitou o resgate de Unidades de Significado e conseqüente construção de três Categorias e respectivas Subcategorias. Na Categoria Gerenciamento da Assistência, constituída pelas subcategorias Protocolo assistencial e Protocolo na dinâmica de trabalho, as enfermeiras abordaram o protocolo como instrumento de trabalho adotado e avaliado segundo as experiências vividas no desempenho da assistência de enfermagem. A categoria Gerenciamento de Recursos Humanos composta pelas subcategorias Profissionais com restrição física; Quantitativo de pessoal e Capacitação de pessoal apontou como dificuldades encontradas para a adoção do protocolo, os problemas relativos aos profissionais com restrição física, as vagas não repostas no quadro de pessoal e a necessidade de capacitação do pessoal. Na Categoria Gerenciamento de Materiais, as enfermeiras discorreram sobre os materiais disponíveis nas unidades para a implementação do protocolo. Nas reuniões do Grupo Focal foram sugeridas estratégias e medidas facilitadoras para a continuidade da adoção do protocolo. Para a concretização das estratégias sugeridas neste estudo e, para que as enfermeiras se apoderem efetivamente desta proposta é imprescindível a realização de reuniões com a participação das enfermeiras e das chefes das unidades, a fim de tornar o protocolo cada vez mais compatível com as necessidades dos pacientes, dos profissionais e da instituição. / This research is a case study with the following objectives: to evaluate the implementation of pressure ulcer prevention protocol (PU) by means of studying the Prevalence and Incidence of PU in the units of Medical Clinic, Surgical Clinic and Intensive Adult Care of the University Hospital, at the University of São Paulo; to apprehend nurses\' perceptions as multiplier agents in the implementation process of the protocol and to propose a systematic and continuous evaluation process in the applicability of the PU protocol. After approval by the Ethics Committee in Research of the University Hospital, collect of data was preceded. The research was performed in two moments. The first, in a quantitative approach, carried out in two phases, to survey the prevalence and incidence of PU in the units of study. The evaluation of risk to develop PU was performed by means of the Braden scale, with a cutoff score of less than or equal to 16. In the Prevalence study, 17 out of the 87 patients developed PU, resulting in a prevalence of 19.5%. In the Incidence study, 35 out of the 190 patients developed a total of 51 ulcers, leading to an incidence of 18.4%. In the second moment, a qualitative approach, data were collected using the techniques of interviews and focus group conducted with the nurses who participated as multiplier agents, in the process to implement the protocol. Content analysis of Bardin was used as a reference for analysis of the Interviews content and Focus group. The interpretative analysis of qualitative data from interviews allowed rescuing the Units of Meaning and consequent construction of three categories and their subcategories. In the Management Assistance category, consisting of the sub-categories Assistance Protocol and Protocol in work dynamics, in which nurses approached the protocol as an adopted working instrument and evaluated it according to their experiences in nursing care. The Human Resource Management Category consisted of the subcategories Professionals with physical restraint; Quantitative of staff and Personnel Training as difficulties found in the adoption of the protocol, problems related to professionals with physical restraint, job postings not fulfilled and the need to training personnel. Regarding the Material Management Category, nurses mentioned about the materials available in the units to implement the protocol. In the Focus Group, strategies and measures were suggested to facilitate the continuous adoption of the protocol. For the implementation of the strategies suggested in this study, and for nurses to effectively take hold of this proposal, it is imperative to perform meetings with the participation of nurses and unit heads in order to make the protocol more compatible with the needs of patients, professionals and the institution.