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Against the background of healthcare reforms in Western European countries, hospitals increasingly engage locum doctors. As independent contractors, they work at the organisational core and are key players in the provision of high-quality healthcare services, making their engagement vital for organisations. Since little is known about locum doctors, and the effects of engaging them at the organisational core, we analyse the work attitudes and behaviours of locum doctors as independent contractors using the example of German hospitals. The analysis is based on a mixed-methods approach combining (1) a qualitative interview study of 21 interviewees, consisting of locum doctors, permanently employed physicians, and hospital representatives to explore the locum doctors' work engagement and to derive testable hypotheses, and (2) an online survey (n = 96) with a between-subjects experiment (group 1 n = 53, group 2 n = 49) as a formal test of the hypotheses. The results indicate that locum doctors are more engaged than permanently employed physicians and have the potential to significantly elevate the organisation's performance. KEYWORDS: autonomy; locum doctor; self-determination theory (SDT); mixed methods; hospital; Germany., INTRODUCTION Over the past two decades, nonstandard work arrangements have become increasingly relevant to organisations and individuals (De Cuyper, de Jong, De Witte, Isaksson, Rigotti & Schalk, 2008; Kalleberg, 2000). [...]

Analysis of discipline of nurses by the Missouri Board of Nursing, 2000-2003, demonstrated differing rates by gender. Males received disproportionately high rates at 18.9%, although they represented 7.5% of Missouri nurses. Males received more severe discipline than females, with higher rates of license suspension and revocation, regardless of infractions or license level. Males surrendered licenses at higher rates. For 3 of the 28 infractions, males exceeded the number of females by a ratio of 2:1. Males committed one infraction that females did not. For three infractions, females outnumbered males by a ratio of 2:1. Females committed eight infractions not committed by males, including four murders. Consistent with previous studies, substance abuse was the behavior disciplined in the majority of cases (41.3%). Disparity in nurse discipline suggests the need for further study to analyze contributing factors, roles that nursing culture and gendered behaviors may play in the disciplinary process. Keywords: men nursing; male nurse; nurse discipline; nurse gender; license discipline

An assessment of the quality of services offered by for-profit (FP) and not-for-profit (NFP) hospitals is presented. Previous studies have shown a relationship between nurse staffing and quality of services. An analysis shows that case mix-adjusted registered nurse staffing was lower in FPs compared to NFPs. It was also found that a lower level of registered nurse staffing resulted in higher levels of mortality and length of stay in hospitals.

Despite evidence that hospital use of licensed practical nurses (LPNs) declined in the 1990s, the current registered nurse (RN) shortage has prompted interest in LPNs as substitutes for RNs. Hospitals, being the dominant employer of RNs, have an economic incentive to use less expensive LPNs as substitutes. Beside wages, there are several forces underlying hospital demand for LPNs. In this article, the authors model and estimate hospital demand for LPNs as a function of nurse wages and hospital, market, and patient characteristics using a longitudinal data set of short-term general hospitals in the United States. The authors find evidence that higher RN wages increase hospital demand for LPNs, both in levels and relative to RNs, suggesting that hospitals at least partially substitute RNs with LPNs. Keywords: licensed practical nurse; nurse labor demand; nurse hospital employment: nurse wages; longitudinal analysis

In response to the nursing shortage, many hospitals offer sign-on bonuses to attract nurses. There are anecdotal reports that the use of such incentives negatively affects staff nurse morale. The present study is the first to empirically examine the reactions of staff nurses who have not received sign-on bonuses. Most of the 800 surveyed nurses were not opposed to the use of incentives, but almost all were concerned about the potential for negative impact on retention. Compared to nurses working in hospitals that did not offer sign-on bonuses, nurses working in hospitals that offer sign-on bonuses reported higher levels of anger and lower levels of optimism. Greater anger and less optimism were associated with a reduced sense of distributive justice. The less fairly treated nurses felt, the greater likelihood of withdrawal from the hospital. The use of recruitment incentives may result in reduced work effort or loss of experienced nurses, exacerbating the nursing shortage. Keywords: recruitment; incentives; retention; distributive justice

A practical nurse rostering problem of an Italian hospital is considered. The nurse rostering is required to generate the nursing staff shifts subject to various operational and contractual requirements.

The job satisfaction and turnover intention of nurses who belong to four community hospitals in Canada are examined over a span of six years. The research reveals that as the years go by the job satisfaction decreased and the turnover intention increased, leaving serious consequences of downsizing and amalgamation.

The effects of hospital restructuring and downsizing on hospital functioning are studied. Restructuring and downsizing has different impacts on hospital performance. Hospitals undertaking restructuring fared well when compared to those with both restructuring and downsizing followed by the ones with downsizing alone.

The National Resident Match Program was created in 1952 to allow medical students to choose which hospitals they want to do their residency in and hospitals to choose which students they wanted as residents. The lists are then matched by computer. The system has evolved as the health care industry has changed.

Hospitals in Ontario have undergone significant restructuring and downsizing during the past few years. Such changes have created negative reactions among both those who survive the downsizing and those who lose their jobs involuntarily. This study compared work satisfactions and indicators of psychological well-being of 36 nurses during these changes and three years later when they were employed elsewhere. Job satisfaction and psychological well-being increased while psychological burnout decreased in this sample.

The more patients an individual nurse has to take care of, the higher the risks of burnout, job dissatisfaction, and patient deaths. This was the conclusion of a study of 10,184 nurses and 232,342 surgery patients at 168 Pennsylvania hospitals. A California law mandates that nurses take care of no more than six patients by July, 2003, but this may be a difficult goal to reach considering the projected shortage of nurses in the US.

Hospital patients who receive a greater amount of care from registered nurses may have better outcomes than those who receive most of their care from licensed practical nurses and nurses' aides. This was the conclusion of researchers who analyzed the medical records of over 6 million patients who were hospitalized in 799 hospitals in 11 US states in 1997.

The impact of job dissatisfaction on labor turnover registered among nurses employed by UK National Health Service (NHS) hospitals is analyzed. Additional information on the key factors leading to job dissatisfaction among nurses and the NHS' initiative to boost the level of job satisfaction to reduce nurse turnover is included.

Some patients with serious medical conditions are more likely to die if they are admitted to a hospital on the weekend than if they are admitted during the week. This was the conclusion of a study of 3,789,917 hospital admissions in Ontario, Canada, between 1988 and 1997.

This paper illustrates how a modem heuristic and two classical integer programming models have been combined to provide a solution to a nurse rostering problem at a major UK hospital. Neither a heuristic nor an exact approach based on a standard IP package was able to meet all the practical requirements. This was overcome by using a variant of tabu search as the core method, but applying knapsack and network flow models in pre- and post-processing phases. The result is a successful software tool that frees senior nursing staff from a time consuming administrative task.

Byline: B. Depasse (1), D. Pauwels (2), Y. Somers (3), J. -L. Vincent (1) Keywords: Nurse training; Nurse staffing; Nurse autonomy; Questionnaire; Intensive care units Abstract: Objective To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. Design A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to be passed on to the nurse-in-charge of their ICU. Results 156 completed questionnaires were analyzed: 49 % were from university hospitals, 26 % from university-affiliated hospitals, and 25 % from community hospitals 42 % of the hospitals had more than 700 beds, 67 % of the ICUs had between 6 and 12 beds, and 54 % were mixed medical-surgical units. Among British units, 79 % had more than three full-time nursing equivalents (FTE) per ICU bed, while in Sweden 75 % of units had less than two FTE/ICU bed. University hospitals had more nursing staff per bed than community hospitals. As regards training, 33 % of nurses followed a training course before starting work on the ICU and 64 % after starting on the unit, and 85 % had easy access to continuing education, particularly in the university hospitals. In an emergency, more than 70 % of nurses regularly initiated oxygen administration, mask ventilation, or cardiac massage. In Sweden 100 % of nurses and in Switzerland 91 % of nurses regularly inserted peripheral intravenous catheters, but only 7 % of German nurses did. No German nurses and only 12 % of British nurses regularly performed arterial puncture, but in Sweden 75 % of nurses regularly did. Conclusion Even though the number of participants were limited, our questionnaire revealed variations in nurse staffing patterns among European countries and in their systems of training and education. Nurse autonomy also varies widely between countries. Author Affiliation: (1) Department of Intensive Care, Erasme University Hospital, Free University of Belgium, Route de Lennik 808, B-1070, Brussels, Belgium (2) Department of Intensive Care, Middelheim Hospital, Antwerp, Belgium (3) Department of Intensive Care, UIA, Antwerp, Belgium Article History: Registration Date: 23/03/2009 Received Date: 30/07/1997 Accepted Date: 22/05/1998