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Biomedical subjects

Peter I Buerhaus

Publications and source records attributed to Peter I Buerhaus.

At least 19 recordsLinked to original sources
PubMed2005

Managing unnecessary variability in patient demand to reduce nursing stress and improve patient safety.

BACKGROUND: Increases in adverse clinical outcomes have been documented when hospital nurse staffing is inadequate. Since most hospitals limit nurse staffing to levels for average rather than peak patient census, substantial census increases create serious potential stresses for both patients and nurses. By reducing unnecessary variability, hospitals can reduce many of these stresses and thereby improve patient safety and quality of care. THE SOURCE AND NATURE OF VARIABILITY IN DEMAND: The variability in the daily patient census is a combination of the natural (uncontrollable) variability contributed by the emergency department and the artificial (potentially controllable) peaks and valleys of patient flow into the hospital fromelective admissions. Once artificial variability in demand is significantly reduced, a substantial portion of the peaks and valleys in census disappears; the remaining censsus variability is largely patient and disease driven. When artificial variability has been minimized, a hospital must have sufficient resources for the remaining patient-driven peaks in demand, over which it has no control, if it is to deliver an optimal level of care. DISCUSSION: Study of operational issues in health care delivery, and acting on what is learned, is critical. Al forms of artificial variation in the demand and supply of health care services should be identified, and pilot programs to test operational changes should be conducted.

Efficiency, Organizational↗
PubMed2005

How RNs view the work environment: results of a national survey of registered nurses.

OBJECTIVE: To determine registered nurses' (RNs') views of the workplace environment. BACKGROUND: Numerous studies have shown relationships between work environment, RN satisfaction and retention, and patient safety and outcomes. In 2002, NurseWeek Publishing and the American Organization of Nurse Executives completed a national survey on the views of RNs on the nursing shortage, workplace environments, and their future career intentions, which revealed areas needing improvement. Results from the follow-up survey conducted in 2004 provide new information on RNs' views of the work environment and a comparison of results to the previous survey. METHODS: A nationally representative random sample of 3500 RNs licensed to practice in the United States was surveyed. RESULTS: In the views of RNs, there have been improvements in a number of aspects of the work environment of nurses. While there are no areas of decline, there are areas in which little or no progress is apparent. CONCLUSIONS/IMPLICATIONS: Some strategies designed to improve the work environment have resulted in positive outcomes, but creative solutions must be continuously developed and implemented to build on recent successes. Results of this survey help identify areas for continued improvement efforts.

Adult↗
PubMed2005

Resident work hour limits and patient safety.

OBJECTIVE: This study evaluates the effect of resident physician work hour limits on surgical patient safety. BACKGROUND: Resident work hour limits have been enforced in New York State since 1998 and nationwide from 2003. A primary assumption of these limits is that these changes will improve patient safety. We examined effects of this policy in New York on standardized surgical Patient Safety Indicators (PSIs). METHODS: An interrupted time series analysis was performed using 1995 to 2001 Nationwide Inpatient Sample data. The intervention studied was resident work hour limit enforcement in New York teaching hospitals. PSIs included rates of accidental puncture or laceration (APL), postoperative pulmonary embolus or deep venous thrombosis (PEDVT), foreign body left during procedure (FB), iatrogenic pneumothorax (PTX), and postoperative wound dehiscence (WD). PSI trends were compared pre- versus postintervention in New York teaching hospitals and in 2 control groups: New York nonteaching hospitals and California teaching hospitals. RESULTS: A mean of 2.6 million New York discharges per year were analyzed with cumulative events of 33,756 (APL), 36,970 (PEDVT), 1,447 (FB), 10,727 (PTX), and 2,520 (WD). Increased rates over time (expressed per 1000 discharges each quarter) were observed in both APL (0.15, 95% confidence interval, 0.09-0.20, P<0.05) and PEDVT (0.43, 95% confidence interval, 0.03-0.83, P<0.05) after policy enforcement in New York teaching hospitals. No changes were observed in either control group for these events or New York teaching hospital rates of FB, PTX, or WD. CONCLUSIONS: Resident work hour limits in New York teaching hospitals were not associated with improvements in surgical patient safety measures, with worsening trends observed in APL and PEDVT corresponding with enforcement.

Adult↗
PubMed2003

Measuring hospital quality: can medicare data substitute for all-payer data?

OBJECTIVES: To assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality-of-care research using administrative datasets. DATA SOURCES: Patient discharge abstracts from state data systems for 799 hospitals in 11 states. National MedPAR discharge data for Medicare patients from 3,357 hospitals. State hospital staffing surveys or financial reports. American Hospital Association Annual Survey. STUDY DESIGN: We calculate rates for 10 adverse patient outcomes, examine the correlation between all-patient and Medicare rates, and conduct negative binomial regressions of counts of adverse outcomes on expected counts, hospital nurse staffing, and other variables to compare results using all-patient and Medicare patient data. DATA COLLECTION/EXTRACTION: Coding rules were established for eight adverse outcomes applicable to medical and surgical patients plus two outcomes applicable only to surgical patients. The presence of these outcomes was coded for 3 samples: all patients in the 11-state sample, Medicare patients in the 11-state sample, and Medicare patients in the national Medicare MedPAR sample. Logistic regression models were used to construct estimates of expected counts of the outcomes for each hospital. Variables for teaching, metropolitan status, and bed size were obtained from the AHA Annual Survey. PRINCIPAL FINDINGS: For medical patients, Medicare rates were consistently higher than all-patient rates, but the two were highly correlated. Results from regression analysis were consistent across the 11-state all-patient, 11-state Medicare, and national Medicare samples. For surgery patients, Medicare rates were generally higher than all-patient rates, but correlations of Medicare and all-patient rates were lower, and regression results less consistent. CONCLUSIONS: Analyses of quality of care for medical patients using Medicare-only and all-patient data are likely to have similar findings. Measures applied to surgery patients must be used with more caution, as those tested only in Medicare patients may not provide results comparable to those from all-patient samples or across different samples of Medicare patients.

Aged↗
PubMedDate not supplied

Nursing students' perceptions of a career in nursing and impact of a national campaign designed to attract people into the nursing profession.

The study assessed perceptions about a career in nursing, the nursing shortage, decision to enroll in a nursing education program, and awareness and effect of the Johnson & Johnson Campaign for Nursing's Future. Data were obtained from a survey administered to a national sample of 496 nursing students. Although most students believe nursing is physically challenging and there is inadequate respect and recognition of nurses, most agree nursing is a good career for men and for people who have academic ability and want a secure job. Although the majority believes the nursing shortage will increase stress on nurses, lower the quality of care, and fail to improve working conditions, most students also expect the shortage will lead to higher pay and more job choices. Information and advice from practicing nurses was the most influential factor in deciding to become a nurse, and friends, parents, and other family members also had a positive influence. Two thirds are aware of the campaign, almost all said it made them feel good about becoming a nurse, and students who are White and enrolled in baccalaureate programs were more likely to be aware of the campaign. Future recruitment initiatives should strengthen the focus on men and minorities, parents and friends, and practicing nurses and nursing educators.

Adolescent↗
PubMedDate not supplied

Nursing students assess nursing education.

This study assessed the characteristics of nursing students currently enrolled in nursing education programs, how students finance their nursing education, their plans for clinical practice and graduate education, and the rewards and difficulties of being a nursing student. Data are from a survey administered to a national sample of 496 nursing students. The students relied on financial aid and personal savings and earnings to finance their education. Parents, institutional scholarships, and government loans are also important sources, but less than 15% of the students took out bank loans. Nearly one quarter of the students, particularly younger and minority students, plan to enroll in graduate school immediately after graduation and most want to become advanced nursing practitioners. Most of the nursing students (88%) are satisfied with their nursing education and nearly all (95%) provided written answers to two open-ended questions. Comments collapsed into three major categories reflecting the rewards (helping others, status, and job security) and three categories reflecting the difficulties (problems with balancing demands, quality of nursing education, and the admissions process) of being a nursing student. Implications for public policymaking center on expanding the capacity of nursing education programs, whereas schools themselves should focus on addressing the financial needs of students, helping them strike a balance among their school, work, and personal/family responsibilities and modifying certain aspects of the curriculum.

Adolescent↗
PubMedDate not supplied

Strengthening hospital nursing.

Hospitals, nurses, the media, Congress, and the private sector are increasingly concerned about shortages of registered nurses (RNs) and the impact on safety and quality of patient care. Findings from a growing number of studies provide evidence of a relationship between hospital nurse staffing and adverse outcomes experienced by medical and surgical patients. These findings have policy implications for strengthening the nursing profession, monitoring the quality of hospital care associated with nursing, and improving the relationship between hospitals and the nursing profession.

Data Collection↗
PubMedDate not supplied

Is the current shortage of hospital nurses ending?

Although hospitals have experienced many shortages of registered nurses (RNs), most have not lasted as long as the current shortage, which began in 1998. However, hospital RNs' employment and earnings increased sharply in 2002, which suggests that the shortage may be easing. Two-thirds of the increase in employment came from older RNs, with the remainder supplied by RNs born in other countries. The employment response of older and foreign-born RNs indicates how the labor market is likely to respond to future shortages, and it emphasizes the challenges confronting policymakers as the RN workforce ages and eventually shrinks in size.

Adult↗
PubMedDate not supplied

International nurses.

Explore the source record for details and available documents.

Foreign Professional Personnel↗
PubMedDate not supplied

Nurse staffing in hospitals: is there a business case for quality?

We construct national estimates of the cost of increasing hospital nurse staffing and associated reductions in days, deaths, and adverse outcomes. Raising the proportion of nursing hours provided by registered nurses (RNs) without increasing total nursing hours is associated with a net reduction in costs. Increasing nursing hours, with or without increasing the proportion of hours provided by RNs, reduces days, adverse outcomes, and patient deaths, but with a net increase in hospital costs of 1.5 percent or less at the staffing levels modeled. Whether or not staffing should be increased depends on the value patients and payers assign to avoided deaths and complications.

Cost Control↗
PubMedDate not supplied

Better late than never: workforce supply implications of later entry into nursing.

Although the number of people entering nursing in their early to mid-twenties remains at its lowest point in forty years, large numbers of people are entering the profession in their late twenties and early thirties. And although it remains unclear why people are becoming nurses later, there is evidence that nursing is attracting interest from different segments of the potential workforce than it was in the 1970s and 1980s. We analyze these trends using data through 2005 and a revised forecast model that still predicts a nurse shortage by 2020, but a smaller one than previously forecast.

Adult↗
PubMedDate not supplied

New signs of a strengthening U.S. nurse labor market?

Wage increases, relatively high national unemployment, and widespread private-sector initiatives aimed at increasing the number of people who become nurses has resulted in a second straight year of strong employment growth among registered nurses (RNs). In 2003, older women and, to a lesser extent, foreign-born RNs accounted for a large share of employment growth. We also observe unusually large employment growth from two new demographic groups: younger people, particularly women in their early thirties, and men. Yet, despite the increase in employment of nearly 185,000 hospital RNs since 2001, the evidence suggests that the current nurse shortage has not been eliminated.

Adult↗
PubMedDate not supplied

Six-part series on the state of the RN workforce in the United States.

This series on the state of the nursing workforce focuses on describing the results of the national surveys of RNs. The series begins with an analysis of RNs' perceptions of the current nursing shortage and whether they perceive the shortage has gotten better or worse over the past few years. Future topics will include RNs' perceptions of being a nurse and how they perceive certain aspects of their jobs; RNs' awareness of the J&J Campaign and whether they think it has been effective; RNs' perceptions of the impact of the shortage on the quality of patient care in hospitals; and various issues related to the age and diversity of the nursing profession.

Advertising↗
PubMedDate not supplied

Is the shortage of hospital registered nurses getting better or worse? Findings from two recent national surveys of RNs.

The results of two recent national surveys of RNs that were conducted at a time when the nursing shortage in the U.S. was in full force (2002) and 2 years later (2004) were compared. The findings provide a mixed assessment: on the one hand, there is evidence that the shortage has eased since 2002 and that there have been notable improvements in the lives of nurses; on the other hand, the shortage has had a negative impact on hospitals and nurses, and longstanding problems associated with the workplace environment remain.

Adult↗
PubMedDate not supplied

Registered nurses' perceptions of nursing.

In Part II of this six part series on the state of the registered nurse (RN) workforce in the United States, the focus is on RNs' perceptions of nursing including RNs' satisfaction with their jobs in general and on specific elements of their work experiences, such as the quality of professional relationships. Satisfaction with a nursing career and whether RNs would recommend nursing to others are also examined. The improvements in nursing found in this analysis of two national surveys in 2002 and 2004 should be broadly communicated not only to energize individuals and organizations to continue their efforts to improve the workplace environment, but to challenge the many individuals in the nursing profession who hold onto a sense that nothing will ever improve in their organizations.

Attitude of Health Personnel↗
PubMedDate not supplied

Awareness and perceptions of the Johnson & Johnson Campaign for Nursing's Future: views from nursing students, RNs, and CNOs.

Johnson & Johnson launched the Campaign in February 2002. Data from surveys of nursing students, RNs, and CNOs reflect a high level of awareness of several key elements of the Campaign--advertisements, recruitment materials, the discovernursing.com Web site, and regional "Promise of Nursing" fundraising events. The J & J Campaign for Nursing's Future represents the largest involvement of the private corporate sector, and through this initiative we are learning new and innovative ways to examine the challenges confronting the nursing workforce and develop actions to help resolve them.

Advertising↗
PubMedDate not supplied

Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care.

The results of analyses of the 2002 and 2004 National Sample Surveys of RNs and the 2004 National Sample of CNOs document the widespread perception that the shortage of nurses is a major problem for the overall quality of patient care in hospitals. In the eyes of the majority of hospital RNs and CNOs surveyed, care processes involving communication, timely response to pages and telephone calls, delays in patient discharges, and the time patients had to wait for tests and procedures were all affected negatively by the nursing shortage. These results are not encouraging.

Attitude of Health Personnel↗