Carol Hatler

ABSTRACT The goal of maintaining the balance between demand for nursing care and the supply of nurses is the basis for state and regional planning to meet future nursing workforce needs. Projecting nursing supply needs solely on the basis of historical registered nurse to population ratios does not specifically consider the healthcare needs of the population. The authors present a model in which state population data and nursing resource data are compared with national data to assist state planning groups in developing an effective workforce management plan. Integrating population demographic data, healthcare needs of citizens, and nurse resource factors at the state level can improve the accuracy of projection statistics.

ABSTRACT The goal of maintaining the balance between demand for nursing care and the supply of nurses is the basis for state and regional planning to meet future nursing workforce needs. Projecting nursing supply needs solely on the basis of historical registered nurse to population ratios does not specifically consider the healthcare needs of the population. The authors present a model in which state population data and nursing resource data are compared with national data to assist state planning groups in developing an effective workforce management plan. Integrating population demographic data, healthcare needs of citizens, and nurse resource factors at the state level can improve the accuracy of projection statistics.

This study attempted to link health care activities and outcomes, taking into account characteristics of the health care system, the work group, and the individual. Results indicated that organizational structure and work group process had a greater influence on cost and derived length of stay (a measure of efficiency) than did the individual-level variables. The findings of this study add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work.

Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice. To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection in patients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest. The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that "fit" with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information. During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients' care resulted in estimated cost savings of 1.0 million US dollars to 2.3 million US dollars. Early, consistent communication about the project's rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.

The literature describes use of a rapid response team (RRT) of critical care nurses and respiratory therapists who arrive at medical-surgical patients' bedsides within minutes of a crisis situation, yet, few articles detail the processes necessary for implementation. The rationale, planning, and evaluation of such an effort at a large, tertiary care hospital in the urban Southwest is described. By describing the development and phased deployment of the RRT, the authors provide key insights into the processes used as well as structures needed and lessons learned.

Many critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients' preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process. PROJECT AND METHODS: The study was to determine if early use of a simple method of identifying a patient's surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N = 203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer.The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients' surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool. Significant differences were found between pre- and post-groups in terms of hospital LOS (F = 6.39, p = .01) and total hospital charges (F = 7.03, p = .009). Project findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians--as suggested in the literature--may have played a role in decreasing LOS and total hospital charges.

While providers, consumers, and administrators recognize the need to attract and retain nurses, recruiting, transitioning, and retaining new graduate nurses (NGRNs) remains problematic. The first 3-12 months of NGRN employment is a perilous and stressful time, with experiences during the transition period profoundly influencing their careers. The purpose of this project was to develop a dedicated transition unit using a theory-driven approach. It addressed employee on-boarding and practice environment issues and it focused on attracting and retaining experienced and newly graduated RNs on an active inpatient unit. Implications are described for those interested in improving the work environment for hospital nurses.

To evaluate venous pool technique (VPT) for obtaining neonatal blood samples as compared with the needlestick technique. An experimental design was used with subjects enrolled in two phases: an equivalence phase (N = 10) and a comparison phase (N = 64). In the equivalence phase, subjects weighing 1,500 g or more had two needlesticks. In the comparison phase, subjects weighing 800 g or more were randomized to receive blood drawn by either needlestick method or VPT. Comparative results suggest that infant and maternal demographic factors, sampling attempts, and sampling failures were similar. However, for the outcome of hematoma development, the standard technique was significantly worse (t = 2.25 ; p = .029). Results suggest that the VPT method is safe and accurate for use in critically ill neonates. This study demonstrated that the VPT process is easily learned and may provide advantages over standard blood sampling methods. Nurses can use this information to evaluate this VPT techn...

Patient falls are a serious problem in hospitals, resulting in substantial morbidity, mortality, length of stay, and costs. The results of a small trial of a patient vigilance system in a post-neurosurgery unit of a large acute care hospital are reported. The system includes two components: (a) passive sensor array placed under the patient in a hospital bed, and (b) a bedside unit that connects to the nurse call system already in place at the hospital. This trial demonstrated the overall effectiveness of the vigilance system in reducing the rate of patient falls. The cost-effectiveness analysis found that use of this system was associated with somewhat higher measured costs. It is likely that the system was cost-saving, due to unmeasured costs.

This study attempted to link health care activities and outcomes, taking into account characteristics of the health care system, the work group, and the individual. Results indicated that organizational structure and work group process had a greater influence on cost and derived length of stay (a measure of efficiency) than did the individual-level variables. The findings of this study add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work.

The literature describes use of a rapid response team (RRT) of critical care nurses and respiratory therapists who arrive at medical-surgical patients' bedsides within minutes of a crisis situation, yet, few articles detail the processes necessary for implementation. The rationale, planning, and evaluation of such an effort at a large, tertiary care hospital in the urban Southwest is described. By describing the development and phased deployment of the RRT, the authors provide key insights into the processes used as well as structures needed and lessons learned.

ABSTRACT Hard economic times have hit the hypothetical Uptown Memorial Hospital. Declining patient volume and reductions in insurance reimbursement resulted in personnel changes in nearly every department and every patient care unit. Staff members of 4 North reflect these changes, with increased absenteeism, grumbling, and rumors of a corporate merger running rampant in the staff lounge. Seldom do staff members share laughter or even pleasantries. Although the staff members of 3 West are part of the same organization, these nurses have responded differently. Nearly everyone says they feel fortunate to have a job where they can make a difference in people's lives. Often the staff lounge contains cards or food to celebrate someone's birthday or other life event, and there's an attitude of “we're all in this together.” How is it that the same circumstances can produce such different results in two groups of people? What is it that enables some to thrive despite difficult events? Psychological resilience may be the answer. Some suggest that resilience building may serve to counteract burnout,1 reduce distress, improve overall well-being,2 and enhance engagement.3 Nurse leaders who can develop resilience in themselves and others are important assets for organizational survival in the future.

This article presents an overview of processes necessary for effective performance improvement (PI) projects and includes a discussion of methodological issues that affect the quality of PI projects. Issues related to project design, project purpose, selection of a representative population for the project, and issues of sampling are presented. Data collection methods and instruments are analyzed and issues related to connecting the problem, the intervention, and the outcome are described. The final sections address strategies related to data analysis procedures and interpretation.

Background Catheter-related bloodstream infection remains an important health problem for hospitalized children. Although placement of a central venous catheter is a life-saving intervention for critically ill children, these same central catheters are a potential source of infection. Objectives Few studies that directly address care of central venous catheters for children in intensive care units have been reported. This evaluation was designed to describe the extent of evidence-based practices for care of insertion sites of central venous catheters in the pediatric intensive care unit of an urban tertiary care center. Another goal was to determine the influence of 2 different regimens for dressing changes on rates of catheter-related bloodstream infections and costs. Methods A convenience sample and an exploratory design were used to collect data in 2 phases, including 30 days to establish baseline information and 30 days each during which patients received dressing care for a cen...

The following consortium members participated in the discussions related to the manuscript topics: Anita Crockett, PhD, RN, director of nursing research, University Medical Center, University of Arizona, Tucson, Ariz.; Melanie A. Brewer, DNSc, RN, FNP-BC, clinical associate ...