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* In this article, the term "churn" is used not only because of the degree of change to staffing, but also because some of the reasons for staff movement are not classified as voluntary turnover. * The difficulties for the nurse managing a unit with the degree of "churn" should not be under-estimated. * Changes to skill mix and the proportions of full-time, agency, and temporary staff present challenges in providing clinical leadership, scheduling staff, performance management, and supervision. * Perhaps more importantly, it is likely that there is an impact on the continuity of care provided in the absence of continuity of staffing. * A greater understanding of the human and financial costs and consequences, and a willingness to change established practices at the institutional and ward level, are needed., GROWING AWARENESS OF THE link between nurse staffing and patient outcomes has focused greater attention on the importance of staffing decisions. However, with prolonged workforce shortages, staffing hospitals with an [...]

Executive Summary * Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-3636 scores. * Medical and nursing diagnoses explained large variations in [...]

* This research examines the influence of clinical provider characteristics, organizational variables, and environmental complexity (EC) on home care nursing utilization as defined by the number and length of visits. * Clinical factors were predictive of visit time. Provider, organization, and EC variables also helped to explain a degree of variation in visit time, but were even more predictive of the total number of visits * Medical and nursing diagnoses explained some large variations in visit length. Specifically, mental health diagnoses contributed to longer, but not necessarily more visits. * Visits performed by degree-prepared nurses resulted in fewer total visits and improved RN perceptions of visit adequacy. * Continuity of care by the primary nurse appeared to increase visit time, but reduced total visits * Managing home health care resources and achieving cost-effective care delivery will be enabled by a better understanding of controllable variables influencing the length and number of home care visits., IN CANADA, like the United States, the delivery of home care services is a large and growing business. The number of home nursing visits in Ontario increased by 88% between [...]

Executive Summary * The authors present a new multifactorial intensity and complexity of care model and meta-paradigm that is designed to examine costs, nursing work, and the variability in resource use across patients and environments. * Relationships were observed among four key variables which included patient-nursing condition, medical condition, caregiver characteristics and the environment. * Patient-nursing complexity and medical complexity are commonly measured by nursing diagnosis and DRG or Canadian case mix groupings (CMG) respectively. * The complexities associated with the work environment had been the least previously studied factors. * Environmental complexity factors include both supply and demand dimensions: scheduling and coordination of procedures, multiple and long procedures, and characteristics and composition of the caregiver team., In the 1980s the emergence of medical case mix groups as the basis for case costing in both Canadian and American hospitals alerted nurses to the need to tease out [...]

Table of Contents Abstract Introduction Methods Results Discussion Conclusions References Abstract The purpose of this study was to compare the outcomes achieved by adult patients who did (n= 78) and [...]

The purpose of this study was to compare the outcomes achieved by adult patients who did (n = 78) and did not (n = 45) receive care by acute care nurse practitioners (ACNP), within one week following discharge. A comparative, cross-sectional design was used. Consenting patients completed the outcome measures within one week following discharge. The outcomes included satisfaction with care, functional status, symptom resolution, and sense of well-being, which were measured with established instruments. The two groups of patients were equivalent in terms of their demographic profile and severity of condition. The results indicated that patients who received ACNP care, as compared to those who did not, reported higher levels of satisfaction with care and of physical, psychological, and social functioning. These findings provide preliminary evidence supporting the contribution of ACNPs to high quality care. However, the small sample size limits the generalizability of the study findings. Keywords: acute care | nurse practitioners | functioning | sense of well-being | satisfaction with care | symptom, Table of Contents Funding Source Introduction Methods Design Setting and Sample Variables and Measures Procedure for Data Collection Data Analysis Results Discussion Conclusions Correspondence Funding Source National Health Research and [...]

* The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care, * The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. * While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. * The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. * This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. * A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial., LITTLE IS KNOWN about the relationship between nurses' work design, how they actually spend their time, and the value and satisfaction they have for the work they are performing. Although [...]