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PubMed1998

The role of the psychiatrist as program medical director.

OBJECTIVE: In a recently published survey of alumni of the Columbia University public psychiatry fellowship, respondents who were medical directors reported performing a greater variety of tasks and experiencing higher job satisfaction than those who were staff psychiatrists. Both medical directors and staff psychiatrists believed that job satisfaction was most dependent on clinical collaboration activities. Survey data were reanalyzed to determine whether there was a relationship between the frequency of tasks performed and overall job satisfaction, and whether the tasks that actually predicted overall job satisfaction were the same as those that respondents believed contributed to job satisfaction. METHODS: The survey was distributed to all public psychiatry fellows and alumni in active practice (N=89), and 72 forms (81 percent) were returned. The survey consisted of 16 self-administered items divided into three categories of job tasks: direct service, clinical collaboration, and administration. RESULTS AND CONCLUSIONS: Despite respondents' beliefs that clinical collaboration activities contributed most to job satisfaction, performance of administrative tasks was found to best correlate with overall job satisfaction. Furthermore, overall job satisfaction was related to the performance of administrative tasks and not to the job title of medical director alone. Most of the medical directors in the survey had program-level, rather than agency-level, responsibilities. The findings indicate that the role of program medical director can serve as a crucial next step for staff psychiatrists, offering the opportunity to perform administrative tasks, which, according to the results, improves job satisfaction in public-sector positions.

Attitude of Health Personnel↗
PubMed1999

Principles underlying a model policy on relationships between staff and service recipients in a mental health system.

OBJECTIVE: The authors participated in a work group to produce a model policy addressing the boundaries of relationships between staff and recipients of service in a public mental health system that provides and regulates services in a variety of treatment settings. METHODS: The chief medical officer of the New York State Office of Mental Health assembled a work group of administrators, clinicians, state officials, and a representative of service recipients. The group reviewed the professional literature and existing ethics guidelines and policies addressing relationships between staff members and service recipients and made recommendations for a new policy. RESULTS AND CONCLUSIONS: The work group formulated five guiding principles: prevention of the exploitation of recipients of services by staff; the right of recipients to be treated as competent autonomous human beings; recognition that certain developmental stages, treatment settings, and pre-existing relationships increase a service recipient's vulnerability to exploitation and call for more stringent regulation of staff actions; acceptance of a spectrum of permissible relationships for staff and recipients outside of the relationship dictated by the staff member's job description; and recognition of the difference between a relationship focused on treatment or service provision and other professional relationships between providers and current or former recipients. The principles were used to develop a model policy on relationships between staff and recipients that addresses both the organizational complexity and the recipient-centered rehabilitation model of a large state-operated mental health system.

Community Mental Health Centers↗
PubMed1991

Head and neck surveillance program for factory personnel exposed to asbestos.

Personnel at a local factory that manufactures brake linings and discs in which asbestos is a major component were requested to participate in an on-site surveillance program to detect head and neck abnormalities, specifically cancer. Demographic data included smoking histories and job descriptions that could be delineated into high- and low-asbestos exposure groups. In the first year, 322 factory workers had no cancer identified but 15% had laryngeal abnormalities, mostly laryngitis. Ninety-seven percent of those workers with abnormal findings were smokers, but there were a significant number in the high-asbestos group irrespective of smoking histories. From this report, high-risk individuals were identified and requested to continue in the program for monitoring. In the subsequent 3 years, these individuals and new personnel were examined. Similar results were obtained in that laryngitis was noted in 24% (95% of whom were smokers) with a stronger statistical association with the high-asbestos group. More important, one person previously identified as high-risk was noted to have stage I squamous cell carcinoma and was treated with radiotherapy. The results of this program suggest that individuals at high risk for the development of head and neck cancer can be identified and that such surveillance programs should be implemented in similar arenas.

Adult↗
PubMed2000

Job characteristics and leisure physical activity.

OBJECTIVES: This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically. METHODS: Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job. RESULTS: Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise. DISCUSSION: The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

Demography↗
PubMed1990

The relationship between technology and task design in hospital nursing units.

An empirical assessment of the use of the Hackman, Oldham, Janson, and Purdy (1975) implementing principles as a theoretical link between hospital nursing unit technology and job design is presented in this paper. While support for the implementing principles as an integrating mechanism was found to be weak, some insights into organization theory are noted and suggestions for future research resulting from this study are outlined.

Analysis of Variance↗
PubMed2003

Measuring the job performance of district health managers in Latin America.

In resource-poor countries, district health managers (DHM) have gained importance as health systems have become decentralized. Although the roles and key functions of DHM have been described in the literature, there appears to have been no analysis of what they are really doing. In this context, the knowledge and job performance of 218 DHM from nine Latin American countries were investigated. The study was based on 12 performance indicators, two self-administered questionnaires (which included internal consistency tests), formal and informal, check interviews in the work place, and direct observations of the DHM. The DHM investigated were found to be particularly weak in systems management (community involvement and intersectoral co-operation), monitoring activities and the systematic organization of meetings. They were rarely involved in the identification of priority health problems or of high-risk groups, and failed to use health-service indicators sufficiently for the analysis of the district health system. The managers were stronger in relation to the organization of technical meetings and the development and implementation of local health plans. Factors associated with good management performance were a favourable organizational structure (including written job descriptions and support from the authorities), 'decision power' (i.e. the ability to select and appoint new staff ) and a good knowledge of the local situation. In Latin America, at least, DHM need to be better prepared, supervised and supported.

Administrative Personnel↗
PubMed2004

The role of the clinical research coordinator--data manager--in oncology clinical trials.

BACKGROUND: The purpose of this study was to determine the standard tasks performed by clinical research coordinators (CRCs) in oncology clinical trials. METHODS: Forty-one CRCs were anonymously surveyed, using a four-page self-administered questionnaire focused on demographics, qualifications, and professional experience. The survey questions on responsibilities consisted of an ad-hoc 32-item questionnaire where respondents had to rate the frequency of involvement in the listed activities using a 3-point scale. We defined as "standard" a task that was rated as "in all or nearly all trials" by at least half of the respondents. RESULTS: A response rate of 90% (37 out of 41) was achieved after two mailings. Less than half of the respondents had received additional training in oncology, clinical research or Good Clinical Practices (GCP). Overall, all standard tasks performed by CRCs were in the category of "monitoring activities" (those usually performed by a Clinical Research Associate "CRA") and included patient registration/randomization, recruitment follow-up, case report form completion, collaboration with the CRA, serious adverse events reporting, handling of investigator files, and preparing the site for and/or attending audits. CONCLUSIONS: CRCs play a key role in the implementation of oncology clinical trials, which goes far beyond mere data collection and/or administrative support, and directly contributes to the gathering of good quality data.

Biomedical Research↗
PubMedDate not supplied

The role of licensed nursing personnel in radiation oncology part B: integrating the ambulatory care nursing conceptual framework.

PURPOSE/OBJECTIVES: To describe the professional opportunities for licensed nursing personnel in radiation oncology within the conceptual framework developed for ambulatory care nurses by the American Academy of Ambulatory Care Nursing (AAACN). DATA SOURCES: Published articles and books. DATA SYNTHESIS: Using AAACN's framework, the researchers identified three roles that are part of every ambulatory care nurse's practice and can be readily customized to radiation oncology: an organizational/systems role, a professional role, and a clinical nursing role. Incorporating the described framework into a radiation oncology nurse's job description can lead to maximizing the use of the professional staff member within the radiation oncology department. This level of professional utilization and validation of the radiation oncology nurse will lead not only to improved patient outcomes but also to greater professional satisfaction, resulting in improved retention. CONCLUSIONS: The complexity of oncology therapies demands expert oncology nurses. This clearly is recognized in medical oncology, and patients with cancer who are being treated with radiation are no less important. To optimize patient care and therapeutic outcomes, the integration of nursing in all aspects of the radiation treatment continuum is essential. IMPLICATIONS FOR NURSING: Radiation oncology nursing is an evolving subspecialty. Nurses can use the information in this article to evaluate their current roles and individual potential for further professional growth.

Adult↗
PubMed2004

Maternal and paternal risk factors for cryptorchidism and hypospadias: a case-control study in newborn boys.

Little is known on environmental risk factors for cryptorchidism and hypospadias, which are among the most frequent congenital abnormalities. The aim of our study was to identify risk factors for cryptorchidism and hypospadias, with a focus on potential endocrine disruptors in parental diet and occupation. In a case-control study nested within a cohort of 8,698 male births, we compared 78 cryptorchidism cases and 56 hypospadias cases with 313 controls. The participation rate was 85% for cases and 68% for controls. Through interviews, information was collected on pregnancy aspects and personal characteristics, lifestyle, occupation, and dietary phytoestrogen intake of both parents. Occupational exposure to potential endocrine disruptors was classified based on self-reported exposure and ratings of occupational hygienists based on job descriptions. Our findings indicate that paternal pesticide exposure was associated with cryptorchidism [odds ratio (OR) = 3.8; 95% confidence interval (95% CI), 1.1-13.4]. Smoking of the father was associated with hypospadias (OR = 3.8; 95% CI, 1.8-8.2). Maternal occupational, dietary, and lifestyle exposures were not associated with either abnormality. Both abnormalities were associated with suboptimal maternal health, a lower maternal education, and a Turkish origin of the parents. Being small for gestational age was a risk factor for hypospadias, and preterm birth was a risk factor for cryptorchidism. Because paternal pesticide exposure was significantly associated with cryptorchidism and paternal smoking was associated with hypospadias in male offspring, paternal exposure should be included in further studies on cryptorchidism and hypospadias risk factors.

Adult↗
PubMed1991

Statistical issues in risk assessment of reproductive outcomes with chemical mixtures.

Establishing the relationship between a given chemical exposure and human reproductive health risk is complicated by exposures or other concomitant factors that may vary from pregnancy to pregnancy. Moreover, when exposures are to complex mixtures of chemicals, varying with time in number of components, doses of individual components, and constancy of exposure, the picture becomes even more complicated. A pilot study of risk of adverse reproductive outcomes among male wastewater treatment workers and their wives is described here. The wives of 231 workers were interviewed to evaluate retrospectively the outcomes of spontaneous early fetal loss and infertility. In addition, 87 workers participated in a cross-sectional evaluation of sperm/semen parameters. Due to the ever-changing nature of the exposure and the lack of quantification of specific exposures, six dichotomous variables were used for each specific job description to give a surrogate measure of exposure. Hence, no quantitative exposure-response relationships could be modeled. These six variables were independently assigned by two environmental hygienists, and their interrater reliability was assessed. Results are presented and further innovations in statistical methodology are proposed for further applications.

Data Interpretation, Statistical↗
PubMedDate not supplied

Nurses' motivation and its relationship to the characteristics of nursing care delivery systems: a test of the job characteristics model.

The purpose of the study was to describe the relationship among motivation, job satisfaction and the characteristics of nursing care delivery systems using the Job Characteristics Model of Work Motivation (Hackman & Oldham, 1980), and to test a framework of nursing care delivery system attributes that have been found to contribute to job satisfaction and good patient care outcomes. The present era of cost containment pressures means that nurse administrators need to ensure that nurses have a work environment with the characteristics of work known to be linked to job satisfaction, motivation and good outcomes. The model was tested with nurses working in medical-surgical areas of four Montreal teaching hospitals. Findings included the applicability of the Job Characteristics Model to the work of nursing and that the addition of four attributes of nursing care delivery systems, namely support for autonomy, communication, adequate time for patient care and the degree of environmental uncertainty contributed to job satisfaction and motivation.

Adult↗
PubMedDate not supplied

Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel.

The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.

Attitude of Health Personnel↗
PubMedDate not supplied

Leadership profiles of senior nurse executives.

As hospitals reorganize to meet the demand for accessible, cost-effective quality healthcare, nursing's active participation as part of the top management team is vital. The purpose of this study was to describe the leadership profiles of four senior nurse executives and determine their congruence with the theoretical perspectives of the stratified systems theory. A multiple case study methodology was employed to develop individual and group leadership profiles through related experiences obtained during an interview, the organization's expectations based on their job descriptions, and a survey of their self-perceptions of how they spent most of their time. The findings indicated that the executives' leadership behavior was consistent with the theory in that they reported more frequent leadership behaviors at the strategic domain, less activity at the organizational domain, and infrequent activity at the production domain. Individual profiles were uniformly consistent with the group profile.

Canada↗
PubMedDate not supplied

Healthcare restructuring: the impact of job change.

Restructuring, particularly redeployment and job change, had a dramatic impact on the working conditions and practices of nursing personnel. This study was conducted to determine whether nurses (RNs and RPNs) who experienced job change perceived their work-lives differently than those who did not undergo job change and, whether nurses who experienced different types of job change (new role, new unit, or new hospital) varied in their perceptions. A questionnaire exploring themes relevant to redeployment was administered to all nurses (N = 3,408) in two large teaching hospitals that had undergone restructuring. The response rate was 50.7% (n = 1,728). Of the responses, 1,662 were used in the analysis. T-tests and ANOVAs were used to compare groups of nurses. Nurses who changed their jobs perceived their commitment to the organization, their work environment and quality of care differently than those who did not change jobs. Nurses with different types of job change differed in their organizational commitment, perceptions of work-related injuries, attitudes towards job change, need for orientation and new knowledge, and feelings about the health care team. Results will assist managers to address the specific needs of nurses with different experiences of job change in the restructured workplace.

Adult↗
PubMedDate not supplied

Advanced nursing practice: old hat, new design.

Advanced practice nurses positively impact the delivery of healthcare and client outcomes. However, in the past these positions have been seen to have variable value and were often vulnerable during budget cuts. Lack of a clear advanced nursing practice (ANP) framework probably contributed to the compromised effectiveness of these roles and evolution of roles with different titles, scopes of practice and reporting structures. To build the foundation for developing an ANP framework, a task force at The Ottawa Hospital (TOH) conducted a literature review related to ANP roles and completed a review of all clinical nursing roles at TOH. In addition, focus groups with nurses and other health professionals elicited ANP perceptions. The ANP framework includes a standardized job description that details competencies under five role components: clinical practice; consultation; research; education; and, leadership. Recommendations for assessment, implementation and evaluation of ANP roles are identified. The process undertaken by our ANP task force proved to be thorough and sound in developing a framework within which to move forward with ANP role implementation throughout TOH. This article, describing the process, may assist other organizations in defining ANP roles to better meet patient needs in changing health care environments.

Clinical Competence↗