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Our goal was to learn about monitoring and enforcement of state assisted living (AL) regulations. Using survey responses provided in 2019 from administrative agents across 48 states, we described state agency structures, accounted for operational processes concerning monitoring and enforcement, and documented data collecting and public reporting efforts. In half of the states, oversight of AL was dispersed across three or more agencies, and administrative support varied in terms of staffing and budget allocations. Operations also varied. While most agents could deploy a range of monitoring and enforcement tools, less than half compiled data concerning inspections, violations, and penalties. Less than 10 states shared such information in a manner that was easily accessible to the public. Future research should determine how these varied administrative structures and processes deter or contribute to AL communities’ efforts to implement regulations designed to promote quality of life and provide for the safety of residents.

Purpose As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. Methods Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia and pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. Results Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207–$1,535,207 and $965,207–$1,005,207, respectively. Conclusions Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.

This article examines the dispute between a hotel owner, operator, and union, and the subsequent litigation. The dispute centered on whether the hotel owner was bound by agreements made between its operator and the union, and whether the operator had a fiduciary duty to the owner. Courts found that the operator was a joint employer of the owner’s employees, and as a result, the owner was bound to agreements that the operator had made with the union. The owner, who did not want to be bound to the union agreement, subsequently sued its operator for alleged breach of fiduciary responsibility. The courts ruled that the hotel management agreement between the owner and operator created no agency relationship and thus no fiduciary duty on the part of the operator. We discuss the potential implications of these findings for union-management relations as well as owner-operator relations, with a specific focus on the implications for hotel owners in the labor context.

Objectives: We explored memory clinic care provision in Minnesota, examining diversity and similarities of services provided and challenges faced. We also considered how well their services and care philosophies aligned with national dementia care practice recommendations. Methods: We created a 53-question interview guide and interviewed 11 memory clinics across Minnesota in late 2019. Interview transcripts were analyzed using Braun and Clarke’s thematic analyses in NVivo 12. Results: We identified 6 themes regarding financial issues, staffing, appointment logistics, care provision during and after the memory evaluation as well as features of an ideal clinic. Conclusions: Memory evaluation and care provision were very different across clinics, primarily due to team make-up, particularly team size and specialty. However, memory care providers shared a passion for providing patient-centered memory care, emphasizing family and patient education and partnership. Their care was largely aligned with national memory care recommendations. Common challenges, including maintaining financial stability and clinic efficiency, exerted significant influence on clinic functioning and survival.

State transportation agencies (STA) are relying on needs-based construction, engineering, and inspection (CEI) consultants as a primary solution to their staffing deficits. While other studies have examined the reasons STAs hire CEI consultants at an agency level, prior research has not identified potential patterns between project characteristics and STA staffing choices. A national survey was administered to examine how the use of CEI consultants differs by project type, work type, complexity level, and the authority level of inspectors. A rigorous model-building variety of Chi-squared analyses, Cochran’s Q tests, McNemar tests, and binomial logistic regression models were used to analyze the data. This research found that STAs are more likely to use consultants on projects with utilities, drainage, roadway, and/or grading because they either do not have enough staff in-house or do not have the experience in-house to complete these projects. Additionally, most STAs do not grant senior inspector consultants the same authority level as their in-house counterparts. Generally, this research indicates that socio-economic and political factors have both short- and long-term effects on staffing choices in public transportation projects and studying project characteristics might help shed more light on the effects of these decisions. Specifically, the results indicate a need for both the private and public sectors to collaborate and share knowledge to preserve institutional knowledge within agencies. These results suggest that further research into staffing trends and project characteristics is warranted.

Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.

Drawing on nationally representative data from six cohorts of beginning teachers from the Schools and Staffing Survey and the National Teacher and Principal Survey, this study applies a difference-in-differences research design to examine the relationship between changes to state-level alternative certification policies and the characteristics of new teachers. The introduction of alternate routes into teaching is associated with an increase in the fraction of new teachers of color in a state and the new teachers who graduated from selective colleges. No evidence was found of a relationship with the relative share of male teachers or teachers of in-demand subjects.

The Christian Caritas and Diakonie are Germany’s largest welfare providers. They currently recruit abroad and in refugee shelters to fill staffing shortages in care. Yet, they also seek to preserve their organisations’ Christian identity. Drawing on interviews with facility managers, my research explores how these initiatives shape institutional life in care homes. Specifically, I examine meanings attributed to conversion, notably in relation to Muslim staff. My analysis shows that Christians, nominal (‘by heritage’) or observant, are seen to ‘naturally embody’ care ethics and have privileged access to permanent contracts and leadership positions. The churches’ politics of identity, I argue, racialises affiliation with Christianity into a category of belonging naturally inhabited by some, and only potentially – and always debatably – attainable for others. The analysis feeds into controversies about conversion in the sociology of race and extends scholarship on identity politics beyond its usual focus on minority or far-right activism.

Prisons depend on their employees, and staffing a prison is expensive. Approximately 80% of a prison’s budget is for staff wages and benefits. Prisons are not generally viewed as desirable places to work, thus recruiting and retaining correctional officers can be difficult. Work-related stress can negatively affect staff members’ home lives, and home stress can make an employee distracted and endangered at work. Time-, strain-, behavior-, and family-based work–family conflicts were hypothesized to impact three work attitudes (job involvement, job satisfaction, and organizational commitment) negatively. Time-based conflict had no significant effects on any of the work attitudes. Strain-based conflict had significant negative effects on job satisfaction and organizational commitment but not job involvement. Behavior-based conflict had significant negative effects on all three work attitudes. Contrary to our hypotheses, family-based conflict had significant positive effects on all three. Work–family conflict is a significant work attitude-associated stressor for correctional staff; therefore, policy recommendations to address it are made.

There are many studies about nurses’ intention to leave their jobs and contributing factors. However, there is a lack of research about generational differences in nurses’ intention to leave. This evidence may help with workforce planning and targeting specific generations of nurses with retention interventions. Using the National Database of Nursing Quality Indicators 2018 Annual Registered Nurse Survey, we used descriptive statistics and multivariate logistic regression to examine the prevalence of and reasons for nurses’ intention to leave in the next year by generational age group. Our sample included 207,636 hospital nurses from across the United States. We found that 21% of nurses ( n = 44,082) reported intention to leave. When comparing generations, there were differences in intention to leave, as well as differences in potentially preventable, career advancement, and personal intention to leave reasons. Workload/staffing was a common reason across generations, indicating that certain interventions may be applicable regardless of generation.

We examined whether effects of an increase in school resource officer (SRO) staffing on school crime and exclusionary disciplinary responses to school crime varied by student race and ethnicity. Using monthly school level administrative data, we compared change in outcomes for 33 schools that enhanced SRO staffing and a matched sample of 72 schools that did not increase SRO staffing at the same time. We found that increases in offenses and exclusionary reactions due to increased SRO presence were most evident for Black and Hispanic as opposed to White students. Educational decision-makers should carefully weigh the benefits of placing SROs in schools against the knowledge that this practice differentially increases recorded school crime and exclusion from school for students of color.

The coronavirus disease 2019 (COVID-19) pandemic has challenged the ability of harm reduction programs to provide vital services to adolescents, young adults, and people who use drugs, thereby increasing the risk of overdose, infection, withdrawal, and other complications of drug use. To evaluate the effect of the COVID-19 pandemic on harm reduction services for adolescents and young adults in Boston, we conducted a quantitative assessment of the Community Care in Reach (CCIR) youth pilot program to determine gaps in services created by its closure during the peak of the pandemic (March 19–June 21, 2020). We also conducted semistructured interviews with staff members at 6 harm reduction programs in Boston from April 27 through May 4, 2020, to identify gaps in harm reduction services, changes in substance use practices and patterns of engagement with people who use drugs, and how harm reduction programs adapted to pandemic conditions. During the pandemic, harm reduction programs struggled to maintain staffing, supplies, infection control measures, and regular connection with their participants. During the 3-month suspension of CCIR mobile van services, CCIR missed an estimated 363 contacts, 169 units of naloxone distributed, and 402 syringes distributed. Based on our findings, we propose the following recommendations for sustaining harm reduction services during times of crisis: pursuing high-level policy changes to eliminate political barriers to care and fund harm reduction efforts; enabling and empowering harm reduction programs to innovatively and safely distribute vital resources and build community during a crisis; and providing comprehensive support to people to minimize drug-related harms.

“Dating Matters®” is a CDC-developed comprehensive, multi-component teen dating violence (TDV) prevention model, made available to the public in 2019. A longitudinal, multi-site demonstration project found that the model significantly reduced TDV during middle school relative to an evidence-based, single-program intervention (Safe Dates; Niolon et al., 2019 ), when implemented across 46 middle schools in four high-risk urban areas with predominantly Black (55%) and Hispanic (28%) youth participants. Research on the costs of implementing TDV prevention strategies is limited, despite recognition within the field of prevention science that such data are critical to widespread dissemination. The current study adds to the available literature on the cost of dating violence prevention by estimating the budgetary impact from the payer perspective of implementing the comprehensive Dating Matters model, compared to Safe Dates, at four sites over four school years to inform prevention planning in communities. Total costs of implementing Dating Matters were relatively stable within sites over time but varied greatly between sites ( M = $175,452 per year; range = $130,149 to $227,604). The mean per-student cost of Dating Matters was $145.40 but also ranged widely ($20.66 to $324.65) across sites and years. Variation was largely driven by staffing costs and number of students served. As expected, total and per-student costs were substantially lower at all sites for the Safe Dates program ( M = $12,148; range = $2,848 to $17,840; $44.81 per student) compared to Dating Matters. This study provides an estimate from the payer perspective to demonstrate the budgetary impact of Dating Matters. These estimates can help inform implementation decisions and planning by potential funders, communities, and organizations as they seek to support and implement effective TDV prevention strategies. It also adds substantially to understanding of the additional costs associated with a move from single-program interventions to community-wide initiatives.

There is limited evidence on the associations between patient safety culture and measures of health care quality in nursing homes. This study examines the relationship between scores on the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. Using data from 186 nursing homes, we conducted multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings. Four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. None of the NH SOPS measures were significantly associated with the Staffing Five-Star Rating. Findings generally indicated that stronger patient safety culture is associated with higher quality ratings.

Purpose: Timely recognition of critical illness is associated with improved outcomes, but is dependent on accurate triage, which is affected by system factors such as workload and staffing. We sought to first study the effect of delayed recognition on patient outcomes after controlling for system factors and then to identify potential predictors of delayed recognition. Methods: We conducted a retrospective cohort study of Emergency Department (ED) patients admitted to the Intensive Care Unit (ICU) directly from the ED or within 48 hours of ED departure. Cohort characteristics were obtained through electronic and standardized chart abstraction. Operational metrics to estimate ED workload and volume using census data were matched to patients’ ED stays. Delayed recognition of critical illness was defined as an absence of an ICU consult in the ED or declination of ICU admission by the ICU team. We employed entropy-balanced multivariate models to examine the association between delayed recognition and development of persistent organ dysfunction and/or death by hospitalization day 28 (POD+D), and multivariable regression modeling to identify factors associated with delayed recognition. Results: Increased POD+D was seen for those with delayed recognition (OR 1.82, 95% CI 1.13-2.92). When the delayed recognition was by the ICU team, the patient was 2.61 times more likely to experience POD+D compared to those for whom an ICU consult was requested and were accepted for admission. Lower initial severity of illness score (OR 0.26, 95% CI 0.12-0.53) was predictive of delayed recognition. The odds for delayed recognition decreased when ED workload is higher (OR 0.45, 95% CI 0.23-0.89) compared to times with lower ED workload. Conclusions: Increased POD+D is associated with delayed recognition. Patient and system factors such as severity of illness and ED workload influence the odds of delayed recognition of critical illness and need further exploration.

The COVID-19 pandemic has led to shifts in healthcare utilization for patients both with and without COVID-19. We aimed to determine how trends in neurology service admissions during the pandemic may aid in departmental planning by predicting future clinician staffing and other needs. We examined all admissions to the general neurology, stroke, and neurocritical care services from January 31 to May 16, 2020 at our tertiary-care hospital using an electronic health record query, comparing these to analogous data in 2019. We trended admission rates and projected future censuses using logarithmic regression, tracked changes in length of stay (LOS), and quantified shifts in presentations of specific diagnoses. Daily rates of admissions declined sharply during the week of March 13, 2020 (the week after pandemic status was declared by the World Health Organization). On the censoring date, we projected a return to pre-pandemic censuses in the week of June 21 and used this information to make decisions regarding neurology resident schedules. There was a trend toward increased LOS for general neurology and stroke patients between March 27 and April 9, 2020 compared to in 2019, with subsequent decline coinciding with early hospital initiatives. Since March 13, 2020, there has been a trend toward reduced presentations of ischemic stroke, suggesting a need for community education on stroke awareness. Characterizing early trends in neurology admissions may allow physician administrators to plan local and community-level responses to the pandemic.

For the last 10 years, the World Health Organization has been celebrating World Hand Hygiene Day on the 5th of May, bringing together the global healthcare ecosystem to celebrate hand hygiene. This day was created to raise awareness about the importance of hand hygiene in healthcare settings, as well as to focus on a specific annual topic to be highlighted to a global audience. The World Health Assembly designated 2020 as the Year of the Nurse and Midwife, and the slogan of this year’s 5th of May was “Nurses and Midwifes: Clean Care is in Your Hands”. This 5th of May helped us to highlight the need for increased staffing and hand hygiene training. In this paper we aimed to raise awareness about the global impact linked to adherence to proper hand hygiene practices by nurses and midwives.

Hospitals have increasingly relied on nurse assistants to support nurses in the provision of patient care, yet knowledge about their contributions to the patient experience in U.S. hospitals is limited. We address this issue by exploring the impact of nurse assistants and registered nurses on an array of patient satisfaction measures from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. Using linked data for 2,807 hospitals from 2008 to 2016, we employ a production function approach to estimate and plot marginal impact curves for both nurse assistants and registered nurses. We find that although registered nurses are more impactful, nurse assistants are the more underdeployed staffing category. We also find that after meeting certain thresholds for minimal hours, nurse assistants have a comparative advantage in improving patient satisfaction scores in the housekeeping and patient support domain. Given their lower labor costs, further employment of nurse assistants may be warranted.

Despite efforts to improve patient experience (PX), little is known about the perspective of hospitalists regarding PX initiatives and priorities. A survey was distributed to hospitalist groups across the country assessing involvement in PX initiatives and their perceived effectiveness, what PX means to providers, and facilitators/barriers in improving PX. Ninety-nine percent of respondents had encountered some improvement activity around PX. The most prevalent were communication training, group Hospital Consumer Assessment of Healthcare Providers and Systems data, and interdisciplinary bedside rounding. Respondents rated most initiatives a 5 to 6 out of 10 for their effectiveness, with the perception of effectiveness increasing with respondents’ assessment of patient experience priority. Learning about others’ experiences in improving PX and learning about potential collaborations for quality improvement or research in these areas were areas of interest for future work. Qualitative work highlighted potential barriers in improving PX such as workload and staffing constraints, uncontrollable environmental factors, and unrealistic patient expectations. Improving PX is a priority, and there are many initiatives in place with perceived variable success and perceived barriers in improving PX.

Frequent visits to the health office can lead to considerable time spent out of the classroom along with affecting relationships and health office resources and staffing. This article features the practice component of continuous quality improvement in the principal of quality improvement in the Framework for the 21st Century School Nursing Practice™ and is the third in a series focusing on the Framework. The article discusses how using multi-tiered systems of support for behavior (MTSS-B) to create expectations for the health office environment, along with intense, individualized plans for specific students, were successful in decreasing health office visits across the school district, with the ultimate goal of increasing instructional time. Outcome data revealed reductions in health office visits with a district-wide decrease of 4.1% one-year postimplementation of the project. More importantly, school nurses are providing better trauma-informed care with intentionality while still meeting the needs of students.

“Boomerang” employees are workers who leave an organization and are later rehired by that same organization. Although many organizations rehire former employees, only a handful of studies have examined this phenomenon. The present study uses a large, longitudinal data set to examine the performance and turnover of boomerang employees rehired into management positions (n = 1,318). Further, we provide some of the first comparisons between boomerang employees and two traditional sources of employees: external hires (n = 20,850) and internal promotions (n = 8,546). Evaluations of job performance before and after being rehired revealed that boomerang managers’ performance tended to remain the same—rather than increase or decrease—after being rehired. Furthermore, boomerang managers performed similarly to internally and externally hired managers in the first year on the job, but both internal and external hires improved more than rehires over time. Internal and external hires were also less likely to turn over from the organization than rehires. Finally, supplemental analyses indicated that boomerang managers who turned over a second time tended to do so for reasons similar to their initial turnover reasons. The overall results call into question some of the assumed benefits of rehiring and suggest that organizations consider factors such as the reason for initial departure, the time horizon of performance, and the availability of other types of hires before considering boomerang employees.

In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.

For preschool children with autism, individual behavioral interventions are among the best-tested treatments. However, they are rarely implemented in special education preschools. We observed one-to-one behavioral interventions formally and informally delivered by staff ( N = 51) in 12 classrooms across three preschools for children with autism, aged 3–6 years, in a major US city. We estimated associations between the use of one-to-one intervention and classroom characteristics including staff-student ratio, professional role composition, and frequency of challenging child behaviors. A small number of classroom characteristics explained considerable portions of outcome variance: 23% for formally delivered one-to-one interventions and 41% for informally delivered interventions. The number of individually assigned personal care aides in the classroom was negatively correlated with less formal delivery of one-to-one intervention. Classroom challenging behavior was positively associated with formal delivery of one-to-one interventions. Interventionist’s professional roles and the number of children in the class accounted for the largest amounts of variance in informal intervention delivery. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff. Lay abstract For preschool children with autism, individual (one-to-one) behavioral interventions are among the best-tested treatments. However, they are rarely used in special education preschools. We observed formally and informally delivered one-to-one behavioral interventions use by classroom staff ( n = 51) in 12 classrooms across three special education preschools for children with autism, aged 3–6 years, in a major US city. We estimated the associations between one-to-one intervention use and classroom characteristics including staff–student ratio, professional role composition, and frequency of challenging child behaviors. As a whole, the factors we examined were considerably important for both formally and informally delivered one-to-one interventions. The number of individually assigned personal care aides in the classroom was negatively associated with the use of formally delivered one-to-one intervention. Classroom challenging behavior was positively associated with use of formally delivered one-to-one interventions. Interventionist’s professional roles and the number of children in the class were most important for the use of informally delivered interventions. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic presents major challenges to places of detention, including secure forensic hospitals. International guidance presents a range of approaches to assist in decreasing the risk of COVID-19 outbreaks as well as responses to manage outbreaks of infection should they occur. Methods: We conducted a literature search on pandemic or outbreak management in forensic mental health settings, including gray literature sources, from 2000 to April 2020. We describe the evolution of a COVID-19 outbreak in our own facility, and the design, and staffing of a forensic isolation unit. Results: We found a range of useful guidance but no published experience of implementing these approaches. We experienced outbreaks of COVID-19 on two secure forensic units with 13 patients and 10 staff becoming positive. One patient died. The outbreaks lasted for 41 days on each unit from declaration to resolution. We describe the approaches taken to reduction of infection risk, social distancing and changes to the care delivery model. Conclusions: Forensic secure settings present major challenges as some proposals for pandemic management such as decarceration or early release are not possible, and facilities may present challenges to achieve sustained social distancing. Assertive testing, cohorting, and isolation units are appropriate responses to these challenges.

Addressing the widespread problem of sexual assault in college environments requires both prevention programming and policies addressing sexual misconduct in institutions of higher education. Through the Campus Sexual Assault Policy and Prevention Initiative, nine programs funded by the Office on Women’s Health approached this problem within a network of eight to 13 campuses apiece, supported by national organizations and local task forces. Near the close of the 3-year project period (June 2016–June 2019), key informant interviews were conducted with project directors and campus representatives. Contextual factors elucidating the project approaches, challenges, and successes were investigated through 31 interviews (nine grantee interviews and 22 campus representative interviews). Analyses across all interview content contributed to the development of several key themes related to staffing efforts to strengthen campus policies and prevention programs, working within institutions of varying structural characteristics, infusing efforts with trauma-informed perspectives, attending to cultural differences across campuses, and seeking to follow recommended guidelines in the context of campus-specific factors. Overall, the interviewees reported specific progress toward the program goals.

The Nursing Working Group of the International Society of Pediatric Oncology developed baseline standards for pediatric oncology nursing care in low- and middle-income countries. The standards represent the foundational support required to provide quality nursing care and address barriers such as inadequate staffing, lack of support, limited access to education, and unsafe nursing environments. The purpose of the current study was to develop and validate an instrument to accurately measure the standards. Content validity was assessed by a panel of expert pediatric oncology nurses from all geographical regions of the World Health Organization. The experts were informed about the study’s purpose and provided the publications used to develop the instrument. The experts rated how well each criterion measured the corresponding standard by using a 4-point scale. A content validity index (CVI) was computed by using the percentage of total standards given a score of 3 or 4 by the experts. A CVI of .98 was obtained from the panel’s evaluation. A CVI of more than .80 is recommended for a newly developed instrument. On the basis of the panel’s recommendations, minor modifications were made to the instrument. We developed and validated the content of an instrument to accurately measure baseline standards for pediatric oncology nursing care. This instrument will aid future research on the effect of nursing standards on clinical outcomes, including mortality and abandonment of treatment, with the potential to influence health policy decisions and improve nursing support in low- and middle-income countries.

Objectives: Working under the constraints of external accountability policy, public school principals are faced with challenges in prioritizing educational goals. Using the Schools and Staffing Survey (SASS) data sets, this study examined the nature and sources of changes in principals’ educational goal priorities in the era of accountability, including the No Child Left Behind Act (NCLB). Method: Difference-in-differences method was used to compare the national average trends of educational goal priorities between public and private schools during 1991–2012 period. Comparative interrupted time series method was also used to explore the impact of NCLB accountability policy on those trends across 50 states. At the school level, logistic regression was applied to examine the effect of NCLB Adequate Yearly Progress status on principals’ educational priorities. Results: While academic goals gained traction over the 1991–2012 period, there were setbacks for other goals of education, particularly personal growth and vocational skills. Notably, public schools’ priority changes were more drastic than private schools’ changes. The divergent trends largely persisted after NCLB across the states. On the other hand, public school principals who previously failed to meet NCLB targets gave more emphasis on basic skills and less emphasis on academic excellence and personal growth. Conclusion: Public school principal’s priorities on academic goals have been shaped by test-driven accountability measures, while other equally important goals have been possibly deprioritized. It gives implications for the implementation of the Every Student Succeeds Act, in which educational leaders can redesign accountability systems and incorporate nonacademic measures for whole child education.

Objective: This paper provides an update on recent developments at the largest state-funded gender clinic for adults in Australia. It focuses on the current staffing profile, the role of the mental health professional and the evolution of the clinic as a provider of specialist care supporting primary care providers who offer an informed consent model of care in accessing gender-affirming treatments. Conclusions: While significant improvements have been made at the clinic to provide comprehensive care in a framework that is viewed more favourably by clients, gaps in clinical service provision persist and are in need of urgent attention.

This research investigates whether teachers’ unions influence student academic achievement in Southern states that prohibit collective bargaining. Our data are from the School and Staffing Survey and the Stanford Education Data Archive. We measure the strength of teachers’ unions by union membership rate and meet-and-confer status of a district and employ a multilevel mixed-effects model to control for unobservable common characteristics of districts within each state. We find that teachers’ unions have a significantly positive association with student test scores, in both math and English, particularly for Hispanic and Black students. This positive link of unions with math is concentrated on the low- and mid-socioeconomic status (SES) districts but is detected across all SES for English.

Background: Most of the previous studies on nursing practice environment and job burnout employed conventional analyses ignoring the impact of unit-level data clusters. This study addressed this gap by examining the effects of the nursing practice environments on dimensions of occupational burnout among a sample of Chinese nurses using multilevel logistic regression models and demonstrating the superiority of employing multilevel models over conventional models within this context. Methods: A proportionate stratified sampling method was applied in this cross-sectional study that invited 1,300 registered nurses (RNs) from nine clinical units of a large, academic hospital in urban China to complete the questionnaire. Nurse-reported information was obtained using the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI). Findings: A total of 1,178 valid questionnaires were returned for a response rate of 90.62%. RNs generally perceived their nursing practice environment as favorable as measured by the PES-NWI. Approximately 40% of the respondents reported experiencing emotional exhaustion and depersonalization. The multivariate models indicated that nurse burnout was significantly associated with nurse participation in hospital affairs, nursing foundations for quality of care, and adequate staffing. In addition, our results illustrated the advantage of multilevel modeling over the conventional modeling for handling hierarchical data in terms of the accuracy of the estimates and the goodness-of-fit of the model. Conclusions/Application to Practice: These findings underscore the importance of measures aimed at enhancing nursing practice environments to prevent RNs from experiencing feelings of burnout and of considering multilevel analysis in future nursing research.

School-based health centers (SBHCs) are an essential part of a comprehensive approach to address the health needs of youth. SBHCs that provide sexual health services (SHS) show promising results in improving reproductive health outcomes among youth. Despite the positive impact SBHCs can have, few school districts have SBHCs, and even fewer provide SHS. This article describes a successful 5-year project to provide SHS through SBHCs in a large county in the southeast United States. A community collaborative, including the schools, health department, community agencies and a local university, was created to address the project goals and objectives. Various steps were taken to plan for the SBHCs, including documenting community support for SHS offered through SBHCs, identifying school sites for SBHCs, and the process for offering pregnancy, STD (sexually transmitted disease), and HIV testing, treatment, and referrals. Protocols for clinic flow, testing, staffing, training, and student recruitment were developed. The staff at the SBHCs were successful in recruiting students to attend educational sessions and to receive testing and treatment. Student feedback was overwhelmingly positive. Lessons learned about the importance of the partnership’s collaboration, using recommended clinic protocol, ensuring clear communication with school staff, and employing youth friendly recruitment and clinic practices are shared.

Using national data from the National Center for Education Statistics 2011–2012 Schools and Staffing Survey and Common Core of Data, we examined the relationship between K–12 practitioners’ risk for stress and the teacher-to-student racial/ethnic congruence. Analyses indicated significant variation in risk for stress by school racial composition and suggested that the likelihood of being categorized as most at-risk for stress is associated with the teacher-to-student racial/ethnic congruence. Findings point to substantial differences in how teachers appraise their environments depending on school context, which has implications for how education stakeholders recruit and prepare classroom practitioners.

In this paper, we conduct a secondary analysis of The Institute of Educational Sciences’ (IES) 2011-2012 Schools and Staffing Survey (SASS) data, a self-reported, nationally representative database to examine: (a) the average caseload of students with disabilities and emergent bilingual learners within and across social studies content areas, as well how social studies teachers’ caseloads compare with other content area disciplines and (b) the extent and perceived utility of professional development opportunities social studies teachers receive to support both students with disabilities and emergent bilingual learners.

The need to provide patient-centered care has been recognized by major players in the health-care field. As such, attention has been placed on patients’ experience of the health care they receive, and health-care organizations have been investing in patient experience initiatives and staffing to implement those initiatives. Given this, the objective for this study was to investigate the qualifications and skills US health-care organizations seek for patient experience positions through a content analysis of job postings. Results show that patient experience positions are largely found in health systems and hospitals. These positions include coordinators, directors, managers, specialists, and advisors. Five key skills were identified: collaborating with stakeholders; coordinating, planning, and executing service excellence programs; handling complaints and grievances; educating and training leadership and frontline employees; and providing excellent customer service. The skills vary depending on the position. The overall goal for patient experience positions is to ensure a complete and positive patient experience. As these patient experience positions are relatively new, requirements will likely evolve over time as organizations adapt patient experience strategies.

Background. For children with complex medical conditions, pediatric home health care is a chronic need. It is a clinical service delivered entirely outside of clinical settings, granting families unparalleled expertise regarding service quality. Methods. Telephone interviews with parents whose children have extensive experiences with home health care. Results: Five themes emerged: (1) benefits of home health care include child survival and family stability; (2) family life is inextricable from home health care schedules, staffing, and services; (3) home health care gaps threaten family physical, mental, and financial well-being; (4) Out-of-pocket costs are common; and (5) families must fight for services as their children’s medical conditions evolve. Conclusions. Families understand better than prescribers, providers, or policy makers what is working, and what is not, with home health care. Family expertise should be the foundation for training other families, clinicians, and home health care agencies, and should be a central component of policy and advocacy in this area.

Background The importance of junior doctor morale is increasingly being recognised. We aimed to identify and explore the factors affecting junior doctor morale in a UK teaching hospital. Methods We carried out an online survey asking junior doctors to rate their morale, rank the top five factors that positively affected morale and offer free-text comments. Results Nine hundred and forty three junior doctors were approached, 402 (42.6%) responded. Overall morale was rated 6 [interquartile range (IQR): 5-8], and how valued 6 (IQR: 4-8), supported 7 (IQR: 6-9) and autonomous 7 (IQR: 6-8) they felt [median ratings using a scale of 0 (low)-10 (high)]. When comparing the four domains of feeling supported, feeling valued, having autonomy and overall morale, respondents felt most supported overall (n = 402, X2 = 85.6, p < 0.0001). Key themes were identified: team working and relationships, feedback, training and education, resources, wellbeing and pastoral support, staffing and workload, senior clinician support, and autonomy. The most common factors positively affecting morale were ‘feeling part of a team’ (66.4%) and ‘being recognised for good practice’ (56.7%). Conclusion We identified a number of diverse themes affecting junior doctor morale. Doctors felt more supported than valued or autonomous, with complex relationships between these domains.

Developments in higher education present disruptions in the normal operations of an academic library. Shrinking budgets, technological innovations, and changes in staffing each cause organizations to question traditional mores and can motivate managers to utilize new ways of thinking to manage workflow and to address evolving institutional initiatives. Knowledge management has emerged as one such way of thinking about management challenges. The authors present basic knowledge management principles, and identify and analyse knowledge management practices at two academic libraries.

Fragmentation of outpatient care is a substantial barrier to creation and maintenance of hemodialysis access. To improve patient accessibility, satisfaction, and multidisciplinary provider communication, we created a monthly Saturday multidisciplinary vascular surgery and interventional nephrology access clinic at a tertiary care hospital in a major urban area for the complicated hemodialysis patient population. The study included patients presenting for new access creation as well as those who had previously undergone access surgery. Staffing included two to three interventional nephrologists, two to three vascular surgeons, one medical assistant, one research assistant, and one practice assistant. Patient satisfaction and perception of the clinic was measured using surveys during six of the monthly Saturday hemodialysis clinics. A total of 675 patient encounters were completed (18.2 average/clinic ±6.3 standard deviation) from August 2016 to August 2019. All patients were seen by both disciplines. The average no-show rate was 19.9% throughout the study period. Patient satisfaction in all measures was consistently high with the Saturday clinic. Providers were also assayed, and they generally valued the real-time, multidisciplinary care plan generation, and its subsequent efficient execution. Saturday multidisciplinary hemodialysis access clinics offer high provider and patient satisfaction and streamlined patient care. However, no-show rates remain relatively high for this challenging patient population.

Summary Locum doctors are often perceived to present greater risks of causing harm to patients than permanent doctors. After eligibility and quality assessment, eight empirical and 34 non-empirical papers were included in a narrative synthesis to establish what was known about the quality and safety of locum medical practice. Empirical literature was limited and weak methodologically. Locums enabled healthcare organisations to maintain appropriate staffing levels and allowed staffing flexibility, but they also gave rise to concerns about continuity of care, patient safety, team function and cost. There was some evidence to suggest that the way locum doctors are recruited, employed and used by organisations, may result in a higher risk of harm to patients. A better understanding of the quality and safety of locum working is needed to improve the use of locum doctors and the quality and safety of patient care that they provide.

© The Author(s) 2019. The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.

Introduction: For children with cancer, early integration of pediatric palliative care in conjunction with curative treatments is recommended. In Switzerland, pediatric palliative care is mostly provided by an interdisciplinary primary oncology team that is mainly composed of nurses. However, only a small fraction of children receive pediatric palliative care and only a minority of them in a timely manner. The main aim was to identify barriers to the provision of pediatric palliative care in Swiss pediatric oncology. Method: This qualitative study consisted of five focus groups. In total, 29 pediatric oncology providers participated (13 nurses, 11 physicians, 4 psycho-oncologists, 1 social worker). Data were analyzed employing applied thematic analysis. Results: Analysis revealed eleven barriers: lack of financial resources, lack of prejob education regarding pediatric palliative care, lack of awareness in politics and policy making, absence of a well-established nationwide bridging care system, insufficient psychosocial and professional supervision for staff, understaffing, inadequate infrastructure of hospitals, asymmetry of factual and emotional knowledge between parents and providers, cultural aspects, irrational parental hopes, and “the unspoken.” Discussion: Awareness should be raised for pediatric palliative care (in particular in demarcation from palliative care in adults) among politics and policy makers which could lead to increased financial resources that, in turn, could be used to improve bridging care, hospital’s infrastructure, and team support. More flexibility for care determining factors is needed, for example, with respect to convening team meetings, short-termed staffing, and reimbursement at the interface between inpatient and outpatient services.

Background: Clinical pharmacy continues to rapidly evolve as does the need to incorporate unique learning opportunities in pharmacy residency training (eg, transitions of care). Objective: To describe the impact of incorporating pharmacy residents into a pharmacist-managed emergency department culture review service (CRS). Methods: This retrospective study included 500 cultures with positive results evaluated by a pharmacy resident during weekend staffing shifts for patients discharged from the emergency department or urgent care center (UCC). The primary outcome of this study was the number of interventions performed by pharmacy residents. Results: Of the 500 cultures evaluated, 275 (55%) required action by the pharmacy residents, resulting in 233 interventions. Modification of antimicrobial therapy occurred 70 times. When surveyed, a majority of residents strongly agreed that the CRS had a positive impact. Based on evaluations, residents achieved mastery of pertinent residency performance objectives. Conclusion: Incorporation of pharmacy residents into a pharmacist-managed emergency department CRS promotes safe and effective medication use to patients discharged from an emergency department or UCC while providing residents additional experience in designing a therapeutic regimen, providing education to patients, and communicating with health-care teams to manage medication therapy.

BACKGROUND: Employer-supported volunteerism has the potential to benefit employees and ultimately have a positive business impact. Volunteerism has been linked to improved quality of life, reduced morbidity, and higher self-rated health. This study was designed to understand what small, rural worksites are doing with regard to volunteerism, and what their barriers are to such activities. METHODS: An online survey was distributed to worksites utilizing the social network of a Resource, Conservation & Development Council, a rural nonprofit entity. Analyses included descriptive statistics, and for qualitative data, review and summary of common themes. RESULTS: Thirty-eight worksites responded, representing a wide range of worksite types. Volunteer activities requiring less time and resources to organize were more commonly employed vs. group-based activities. Identified barriers included time, costs, small staffing numbers, perceived employee lack of interest, worksite policies, distance to volunteer sites, language barriers, and lack of awareness of opportunities. CONCLUSIONS: Despite a variety of challenges, some forms of employer-supported volunteerism seem feasible even in very small rural worksites. Worksite type, culture and leadership are likely to be determinants of the extent and nature of employer-supported volunteerism. APPLICATIONS TO PRACTICE: Strategies to encourage greater volunteerism need to be tailored to the interests and resources of each site. Occupational health nurses should consider incorporating some form of employee volunteerism activities within their health promotion programming as it is consistent with an overall strategy of enhancing employee well-being. This could lead to positive business impacts such as increased employee engagement, improved recruitment and retention, and improved productivity.

Geographic isolation of K-12 schools represents a unique challenge to schools with implications for school funding, staffing, resource acquisition, consolidation, transportation, and school choice among others. To date, little research has documented the extent of geographic isolation at a national scale or how it varies across school contexts. Using the Common Core of Data and the Private School Universe Survey, this study estimates the extent of geographic isolation nationally and explores how such isolation varies across contexts. Estimates are calculated and compared using as the crow flies distance, road travel distance, and travel time. Results indicate that geographic isolation of schools is relatively high within district, particularly in rural areas. Although inclusion of schools in nearby districts greatly reduces isolation, many local markets of schools remain small. Results further show that geographic isolation varies greatly across states and across student demographics. Implications for policy are discussed.

Objective Burnout is a significant problem affecting the nursing workforce and is associated with significant personal suffering and high rates of nurse turnover. Efforts to further understand the variables that explain burnout are needed. The aim of this cross-sectional study was to examine both environmental and individual factors that may explain burnout among nurses. Method We recruited 1848 Australian nurses to complete several online questionnaires measuring the practice environment (Practice Environment Scale of the Nursing Work Index), burnout (Professional Quality of Life Scale), trait negative affect ( Spielberger State-Trait Anxiety Inventory form Y2) and resilience (Connor Davidson Resilience Scale). Correlational analysis as well as hierarchical regression was used to determine the relative importance of variables in explaining burnout scores. Results All of the practice environment scales were significantly related to burnout in the negative direction, and these relationships were above .3 for all except the relationship scale ( r = –.256) and the participation in hospital affairs scale ( r = –.285). Overall, the regression model accounted for 62% of the variance in nurse burnout scores. Trait negative affect, resilience and two aspects of practice environment (Manager sub-scale and Staffing sub-scale) all explained significant variance in burnout scores. The largest contribution came from the two individual variables (resilience and trait negative affect) that together explained 55% of the variance in burnout scores. Conclusions Findings suggest that health service administrators should provide nursing staff with education and support to build individual resilience. Workplaces that attend to staffing and resource issues and have managers who provide high levels of support to their staff appear to be essential strategies to help prevent nurse burnout.

In this study we describe nurse–physician teamwork, estimate its association with surgical patient outcomes (30-day mortality and failure-to-rescue), and determine whether these relationships depend upon other modifiable hospital nursing characteristics (nurse staffing and education levels) known to be associated with patient outcomes. This cross-sectional analysis included linked data from 29,391 nurses representing 665 acute care hospitals and 1,321,904 adult patients who underwent a general surgical, vascular, or orthopedic procedure. Surgical patients cared for in hospitals with better nurse–physician teamwork had significantly lower odds of 30-day mortality (odds ratio [OR] = 0.95) and failure-to-rescue (OR = 0.95). In addition, the odds of death and failure-to-rescue were lower for patients in hospitals with both higher nurse–physician teamwork and more favorable patient-to-nurse staffing ratios. Similar trends were observed related to nursing education levels. Improving interprofessional teamwork is one strategy to improve patient outcomes with the added importance of also considering additional features of their nursing workforce.

Background and Purpose. The American Heart Association recommends community-based research on shared use of physical activity (PA) spaces. Pasadena, a community in southeast Houston, Texas with lower socioeconomic status and racial/ethnic diversity, was the setting for our study. Efforts to increase access to PA in Pasadena include building the evidence on PA resources. The purpose of this research was to utilize survey data in a community setting to inform and target efforts around sharing PA spaces. Method. An online survey was administered to K-12 school ( n = 25) and park ( n = 30) administrators, church leaders ( n = 10), community organizations ( n = 2), a health care center, and a local business. Results. Park facilities in Pasadena shared by agreement with two high schools and three baseball/softball leagues were ballfields, tennis courts, and jogging paths. No park facilities were shared with faith-based organizations. Four parks communicated daily, and five schools communicated with parks quarterly about providing opportunities for PA. Key facilitators to sharing facilities were building relationships and collaboration, service to the community, and improving health. Key barriers were cost, maintenance, staffing, and prioritizing use with limited time, facilities, and resources. Conclusions. This study is the first of its kind to address shared use at the community level and suggests opportunities to improve communication and partnerships between parks, schools, and churches. This research will inform ongoing efforts to promote access by identifying barriers and motivators among stakeholder groups to help facilitate shared use agreements.

In 2003, the Chinese government began the use of community corrections to guide the reeducation and reform of offenders. Scholarly research within the field of community corrections has since begun, but the development of Chinese community corrections research is still in its infancy. There is little information about offenders and community corrections’ institutional organization and staffing. There is a dearth of comprehensive studies on the administrative process of community corrections, particularly pretrial investigation, transition of offenders, supervision, and a reward and punishment system. Thus, this study explored these flaws and omissions through research on offender profiles and the supervisors responsible for the development of Chinese community corrections.

Nursing home resident obesity increases the complexity of nursing care, and nursing homes report avoiding residents with obesity when choosing which prospective residents to accept. The objective of this study was to examine the associations between nursing home obesity prevalence rate and nursing home organizational, staffing, resident, and geographic factors within a profit maximization framework. The study cohort included U.S. Centers for Medicare and Medicaid Services data from U.S. nursing homes in 2013. Study findings supported hypothesized associations between obesity prevalence rate and higher occupancy, higher bed capacity, and multi-facility affiliation, but findings did not support a relationship between obesity prevalence rate and for-profit status.