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A staff midwife describes what it is like to be back on the Maternity Unit after a break of 11 years and a "return to practice" course. It is a steep learning curve but she finds the work fulfilling.
The Public Health Institute in Trnava, Slovak Republic under coordination of the International Agency of Cancer Research (IARC) at Lyon, France, had completed a retrospective cohort study of cancer occurrence among nuclear workers at Jaslovské Bohunice, Slovak Republic, as part of a multicentric cohort study of 14 countries. The objective of the study was to assess an impact of a long-term low level ionising radiation on cancer occurrence. In summary, 2776 employees had been selected for the follow-up period, which lasted since January 1, 1973 till December 31, 1993, it means for 21 years. Mean age at beginning of follow-up was 28.9 years and at the end of follow-up 39.6 years. The total number of person years was 27,742.1 of males and 2,442.2 of females. Exposure was expressed as annual cumulative dose of each cohort member. The total cumulative external gamma dose over the follow-up time was 58,187.9 mSv. The average external gamma dose per person years was 2.06 mSv of males and 0.37 of females. Socio-economic status, described by the last job description and education were used as possible confounding variables. All cause mortality, cancer caused mortality and cancer incidence were assessed comparing with general Slovak population using indirect standardised mortality ratio or incidence ratio calculations. There were 47 deaths reported, 44 males and 3 females, over 21 years of follow-up. The most frequent causes of death were cancer (about 30%), accidents, suicides and other external causes (about 26%), cardiovascular diseases (23%). Standardised mortality ratios of 0.39 (0.386-0.392) and 0.46 (0.27-0.59) for males and females, respectively were found in case of all cause mortality. In case of cancer mortality the standardised mortality ratios (SMR) were 0.44 (0.42-0.47) and 1.35 (0.84-1.86) for males and females, respectively. There were 32 incident cases of cancer observed during follow-up. Standardised incidence ratios as 0.508 (0.49-0.52) and 0.905 (0.74-1.06) for males and females, respectively were found. Dose response relation was measured using Poisson regression and Cox proportional hazard model. The estimated excess risks in both approaches and both for mortality and morbidity study were rather anecdotal due to lack of statistical significance caused by small number of cases.
OBJECTIVE: The aims of this study were to describe job characteristics for daytime and shift workers in home care services for the elderly and to clarify health care in the work setting, social support, and job satisfaction and possibilities. METHODS: A self-reported questionnaire was given to 433 home care workers, both full time and part time (more than 15 hours), at 35 institutions that provide home care services to residents of Sapporo (return rate; 80.2%). The following issues were investigated: job content (physical care, assistance with housework, and advice), specialty, job satisfaction, possibilities, job training, health care and social support. The results were compared among employed types: full-time and part-time daytime and shift workers using the t-test or the Fisher's test. RESULTS: The participants demonstrated high dissatisfaction with wages, physical uneasiness themselves and limited social support from their supervisors. Especially full-time workers were dissatisfied with the payment, whereas part-time workers complained about insufficient attention to the prevention of lumbago. It was found that part-time daytime workers were given insufficient on-job-training and education for prevention of infection, and that full-time shift workers greatly wished to leave the employment. However, the home care workers were satisfied with their job itself and expected to continue their work. Furthermore, half of the part-time workers hoped to work full time. CONCLUSIONS: Health management and educational training for part-time workers may be necessary to improve the quality of care services and protection of health. Promotion of full time employment and reconsideration of working condition might be necessary to provide sufficient home care services.
This summary article discusses the status of the nursing shortage in the United States, with emphasis on successful strategies to address it. Liaisons between the American Association of Critical-Care Nurses (AACN) and the Society for Critical Care Medicine, as well as with the American College of Cardiology, are highlighted, with primary emphasis on the strategy of nurse-physician collaboration.
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We examine the clustering of attendance, illness, and accidental injury problems in a large unionized manufacturing plant using both quantitative and qualitative methods. We find that the distribution of workers into problem groups is related to 1) conflicts over seniority, 2) physical stressors and their influence on perceived desirability of certain kinds of jobs, and 3) organizational conditions and environments congenial to the development of distinct occupational "subcultures." We suggest that the case study approach we apply in this paper is critical to the design of programs of preventive intervention and complements the more commonly applied multiple-site and individually focused, survey approaches.
Discussion reported in the present article could be the basis for a reflection about how to plan and act the nurses' evaluation in a health structure. Within this framework, the following issues have been discussed: what kind of organizational implications could be related to an evaluation system? What are the most important elements in a nurses' evaluation plan? How can the nurses' evaluation be inserted in the directional process? What are the elements to be considered in a nurses' evaluation plan? The analysis makes evident the link between the organizational factors of each structure and the elements to consider in a system of nurses' evaluation. As a result, the nurses' evaluation tools must be studied in their specific context.
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The development, implementation, and evaluation of a program that incorporates a registered nurse and licensed vocational nurse partnership model into the critical care practice setting is described. This model can be used by nurse executives to alleviate some of the immediate consequences of the nursing shortage and potentially to achieve a longer-range solution by expanding the pool of registered nurses. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by registered nurses and physicians of increased nursing care quality; decreased registered nurse turnover and sick time; and a positive perception of the role of the licensed vocational nurse in the critical care unit.
The OSHA regulations, which took effect March 6, 1992, require that all employees be trained in infection control practices when they are hired, their job description changes, or the standards for universal precautions are revised. An explanation, provided to inform employees where a copy of the OSHA standard can be reviewed should be available at each clinical and surgical site, and OSHA regulation definitions must also be posted. The OSHA regulation applies to any clinical, housekeeping, or administrative staff that has any potential risk of exposure to blood or other potentially infectious substances.
AIDS outreach workers operate at the frontlines of the AIDS epidemic to provide information and education to high-risk individuals. Recent reports indicate that these workers have been effective in helping to reduce high-risk behaviors. However, a review of retention data for 62 outreach workers employed from 1986 to 1988 at a private nonprofit research institute indicated a high rate of turnover, especially among males. The literature provides little information regarding the demographic characteristics of outreach workers and their sources of job satisfaction and dissatisfaction. This exploratory investigation was undertaken to address these topics. Structured interviews were conducted with 20 currently active outreach workers. Results indicate that altruistic motives were most frequently cited as reasons why people became outreach workers and also provided the primary source of satisfaction. Stress was most frequently mentioned as a source of dissatisfaction and also as a reason previous workers had left outreach work. Conclusions focus on the outreach workers' suggestions for job improvements. These included: improvement in the terms of employment (e.g., salary, benefits); more education and training opportunities; and more support groups or help with recovery.
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This study analyzed the roles, functions, and job satisfaction of 65 master's prepared occupational health nurses employed within the health care industry to compare nurses who function as internal consultants with those who function as external consultants. The only significant difference between groups was that external consultants were more involved in marketing and management functions, whereas internal consultants were more involved in direct care. The study hypothesis that occupational health nurses performing more management functions would report greater job satisfaction was not supported by the data. Study findings did support a theoretical model by Hardy, revealing that greater role certainty and more role adapting behaviors were significantly associated with job satisfaction.
Management personnel expressed concern that the allocation of work was not properly aligned to permit maximum efficiency in the supervisor job family. Employees at various levels in the supervisor job family also felt that there needed to be greater definition regarding which tasks needed to be done by which level in the organization. Using data collection and interviews, a team of staff employees and consultants successfully evaluated the facility operation and supervision. The information was analyzed and compared with the existing supervisory job descriptions. An action plan was developed and presented to management personnel to increase efficiency and stratify the responsibility of the existing supervisory levels. Supervisory reassignment was proposed.
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At North Shore Magnetic Imaging Center, the patient paper medical record system was becoming very cumbersome, and it served as a source of frustration for everyone involved: patients, technologists, radiologists, and staff members. The center's mapping of a typical patient experience indicated that, from the initial phone call scheduling an exam to a completed visit (claim processed and payment received), a record could be handled by as many as 20 sets of hands! In June 2002, the center's growth and a concern that patients were losing a one-on-one experience with the medical staff led to an evaluation of workflow processes existing at that time. The evaluation began with a survey of staff members, center management, radiologists, and referring physicians. Their responses indicated 3 common themes: stress, overload, and frustration over systems in place. Comments from the survey were grouped into 3 areas: Continue to Do, Stop Doing, and Start Doing. The Start Doing responses provided solid objectives. The center set out to establish a breakthrough project that included all stakeholders--patients, staff, management, and radiologists. The Reinvention Project had 2 primary goals: move to a paperless environment and increase the level of patient care. The project was divided into internal and external teams. The internal team, called the Reinvention Team, was responsible for the actual hands-on aspects of the process. There were numerous external teams; each had defined roles and specific outcomes for achievement. The external teams' responsibilities included implementing an Internet protocol telephone system; researching voice recognition; restructuring job descriptions, training manuals, and performance evaluations; and conducting a patient-centered focus group.