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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Nursing personnel downsizing in a teaching hospital].

The objective of this study was to adjust the downsizing of nursing personnel in a teaching hospital to the resolution of Federal Nursing Council no. 293/2004. The classification of patients in levels of complexity care was done and the required time for the nurse care also was verified. The present number of employees was compared to the measured one. The outcomes showed the levels of patients'care complexity is on intermediate care (42%), and the required time to the nurse care was greater on intensive care patients (42%). The present staff has a deficit of 205 nurses and an exceding of 284 professionals of techinical college level.

Brazil↗
PubMedDate not supplied

Physiological changes associated with downsizing of personnel and reorganisation in the health care sector.

BACKGROUND: The objective of this study was to assess potential physiological changes associated with downsizing/reorganisation in the health care sector. The personnel reductions (1995-1997) in the studied regional hospital corresponded to one fifth of the personnel. METHODS: In a longitudinal study, female personnel had blood sampled twice (8 a.m. and 4 p.m.) during a working day in 1997 (in connection with the last completed round of personnel redundancies) and 1 year later in 1998. The participants were 31 women (82% of those initially sampled ); there were 14 registered nurses, 11 assistant nurses and 6 medical secretaries. No additional drop outs took place during follow-up. Outcome variables were changes in the difference in serum cortisol levels between the morning and afternoon and in serum/plasma concentrations of immunoglobulin G (IgG), oestradiol, dehydroepiandrosterone sulphate (DHEAS), prolactin and apolipoproteins AI and B. RESULTS: Significantly decreased serum/plasma concentrations of IgG (p < 0.001), apolipoprotein AI (p < 0.001) and oestradiol (p < 0.001) were found. The difference between morning and afternoon serum cortisol decreased, with a change at the significance level of p = 0.05. No significant changes were observed regarding prolactin, DHEAS and apolipoprotein B. CONCLUSIONS: These results could be an indication that protective and anabolic functions had suffered in these remaining 'ageing' female work groups. The circadian cortisol rhythm was possibly flattened, which could be a sign of physiological dysfunction associated with the long-lasting adaptation process. These conclusions are tentative, given the small size of the sample and the lack of a control group. However, the findings point to the significance of studies of physiological changes possibly associated with restructuring of the health care sector.

Adult↗
PubMed2006

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress.

The purpose of this paper is to examine the effects of job preference, unpaid overtime, importance of earnings, and stress in retaining nurses in their employing hospitals and in the profession. Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario, Canada. Data are analyzed first for all nurses, then separately for full-time, part-time, and casual nurses. Results show that the key to understanding the effects of these variables may be to pay attention to the work status of nurses. With regards to retaining nurses in their hospitals, working in their preferred type of job is important, particularly for part-time nurses. Working unpaid and longer than agreed hours is also a factor for increasing the likelihood of part-time nurses to leave the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but it is particularly important for part-time nurses. Stress is an ongoing concern for retaining nurses in their hospitals and within the profession. We suggest managers and policy makers pay attention to employing nurses in jobs they prefer, decrease unpaid overtime, and consider the importance of earnings for them and their families in developing policies and programs to retain nurses. More importantly, stress levels should be lowered to retain nurses.

Attitude of Health Personnel↗
PubMed2001

Clinical dietetics changes due to cost-reduction activities in healthcare systems.

OBJECTIVE: This study was designed to assess changes in clinical dietetics due to cost-reduction activities in healthcare systems. SUBJECTS: 1,200 ADA members who indicated that they were employed by acute care hospitals in ADA Area 2 states. DESIGN: A questionnaire about changes in clinical dietetics staffing and clinical dietitians' activities and responsibilities was developed based on qualitative research. Descriptive statistics, t tests, analysis of variance, chi2 tests, and correlations were calculated. RESULTS: A total of 342 usable questionnaires (28.5%) were returned. More than one third (37.9%) of respondents reported reductions in the number of clinical dietitians, and 32.2% reported increases in the number of part-time clinical dietitians. Most respondents indicated that they were more involved with high-risk patient interventions, had limited time for inpatient instruction, and experienced an increased patient caseload. Although 45.4% of respondents reported diminished job satisfaction due to recent changes in healthcare systems, some changes, such as increased high-risk patient intervention and referrals, were positively correlated with perceived job satisfaction. DISCUSSION: Thorough review of current clinical dietetics activities/responsibilities and planning before cost-reduction, restructuring activities may maximize staff utilization without decreased job satisfaction of clinical dietetics staff.

Clinical Competence↗
PubMed1998

Psychosocial stressors and well-being in health care workers. The impact of an intervention program.

There have been few prospective studies of the impact of workplace interventions on employee and organizational well-being within health care settings. This study was conducted at a large regional hospital in Sweden in 1994 with a follow-up in 1995. Effects of a structured organizational and staff intervention program on perceived psychosocial work quality, supporting resources and self-reported health and well-being were evaluated. Based on department-specific results from the baseline assessment in 1994, each department formulated their own improvement goals. They also made their own decisions on relevant improvement activities. Since there was no formal reference group in this study, departments with high and low rating levels, respectively, with regard to intervention activities were compared. Despite an overall worsening in most of the measures most likely due to a notice of 20% staff reduction prior to the follow-up assessment, the intervention appeared to have attenuated negative changes in the high as compared with the low activity group. Manager-rated impact of the program as well as positive staff attitudes and staff involvement in the enhancement process were identified as important determinants for more favourable changes. The study points out the relevance of structured workplace interventions for organizational and employee well-being especially in times of cut-backs and organizational turmoil. Department-specific factors will determine the impact of such programs. The study indicates that the psychosocial impact of personnel cut-backs in health care may be attenuated through management initiatives.

Efficiency, Organizational↗
PubMed2005

The role of change in the relationship between commitment and turnover: a latent growth modeling approach.

Through the use of affective, normative, and continuance commitment in a multivariate 2nd-order factor latent growth modeling approach, the authors observed linear negative trajectories that characterized the changes in individuals across time in both affective and normative commitment. In turn, an individual's intention to quit the organization was characterized by a positive trajectory. A significant association was also found between the change trajectories such that the steeper the decline in an individual's affective and normative commitments across time, the greater the rate of increase in that individual's intention to quit, and, further, the greater the likelihood that the person actually left the organization over the next 9 months. Findings regarding continuance commitment and its components were mixed.

Adult↗
PubMed2005

Are trends in work and health conditions interrelated? A study of Swedish hospital employees in the 1990s.

Swedish hospital personnel were followed over an 8-year period, characterized by staff redundancies and restructuring processes. Self-rated and administrative data sets from 1994 to 2001 allowed for studying long-term consequences of organizational instability for staff health and work conditions. The aim was to identify, on a work-unit level, trends in work and health conditions and their interdependence. Regression analysis showed a downward trend in mental health and an upward trend in long-term sick leave. Increasing trends of work demands were accompanied by deteriorating mental health, and decreasing time to plan work showed the strongest association with increasing long-term sick leave. Job satisfaction and support were decreasing. A stable short-term sick leave rate over years related to lack of support.

Adult↗
PubMed2001

Effect of a changing health care environment on social work leaders: obstacles and opportunities in hospital social work.

The health care system is undergoing dramatic change in auspice, structure, and services delivery in response to an emphasis on market-driven, cost-containment strategies. Consequently, many hospital social work directors either have lost some of their administrative responsibilities or have expanded their span of control beyond social work services. This article examines the responses of social work administrators to the breadth of changes occurring throughout their hospitals; the major accomplishments of social work services within their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. As a result of examining the relationship between their actual and anticipated behavior and changes in the hospital and external environment, the authors found that social work leaders in hospitals understand the complexities and challenges of the world around them. Overall, they have exhibited commitment, competence, and confidence in shaping organizational change.

Hospital Administrators↗
PubMed1998

SDM95--reducing aggregate care team costs through optimal patient placement.

The authors describe a new approach that designs optimal patient placement rules and staffing-to-demand scheduling schemes. The placement rules enable care teams to deliver care at census levels that maximize the productivity of current care models across aggregated units and reduces the number of units experiencing census variation. The scheduling schemes ensure that staff is available to meet patient needs so that work schedules become predictable and premium pay virtually is eliminated.

Bed Occupancy↗
PubMed2001

Hospital RNs' job satisfactions and dissatisfactions.

In a survey addressing work-related stress, 1,780 registered nurses (RNs) discussed the many variables affecting their job satisfaction, including: why they chose nursing, patient care issues, nurse manager roles, salaries and benefits, and intent to stay in nursing. Their responses may be painful for nursing management to read. Yet, if new candidates are to be attracted and existing RNs retained, satisfaction of RNs with their jobs must be considered.

Adult↗
PubMed2003

The effect of LPN reductions on RN patient load.

OBJECTIVE: This study explores the effect of licensed practical nurse (LPN) reductions on registered nurse (RN) staffing. BACKGROUND: RN staffing is usually evaluated by assessing RN/patient and RN/nursing staff ratios. Using these measures, researchers generally have not found deterioration in RN staffing. Despite differences in roles, RNs and LPNs frequently share a substantial amount of patient load. Given reductions in LPNs, adequate RN staffing can be assessed more completely by looking at the changes in the staffing of licensed nurses (RNs and LPNs combined). METHODS: This study measures the percent change in RN, LPN, and licensed nurse staffing from 1991 to 2000 in 185 to 215 Pennsylvania hospitals. Paired sample t tests measure the significance of change from year to year and for the period overall. RESULTS: A 29% reduction in LPNs during the years 1991 to 2000 affected RN staffing through an increase in licensed nurses' patient load and a slight decrease in skill mix. When adjusted for acuity, both RN and licensed nurse patient load increased significantly. CONCLUSIONS/IMPLICATIONS: These results help explain the perception that hospitals are understaffed. Future research and managerial decision-making should consider the adequacy of licensed nurse staffing, and its impact on cost, performance, and quality.

Attitude of Health Personnel↗
PubMed2004

Nurse staffing and hospital ownership in California.

OBJECTIVE: The purpose of this study is to describe the relationship between nurse staffing and owner type or specific corporate owner in California acute care hospitals. BACKGROUND: Little empirical data exist regarding nurse staffing as it relates to owner type or specific corporate owner. With minimum staffing ratios scheduled to be implemented in January 2004, this study provides baseline data for evaluating the impact of minimum staffing ratios in California. METHODS: The study design is descriptive and cross-sectional. Data used in this study are for short-term general hospitals that reported to the California Office of Statewide Health Planning and Development database for fiscal years ending in 1997 through 1999. Six regression models were estimated using pooled data from the 3 years of data. RESULTS: The most consistent significant findings are: increased patient days or patient discharges predict increased registered nurse (RN) hours; lower RN wages predict increased RN hours; higher technology scores predict increased RN hours; and in 1998 there was an across-the-board decrease in RN hours. Other significant findings include that for-profit hospitals and for-profit systems had fewer RN productive hours for medical-surgical nursing, and select corporate owners, unrelated to profit status, had consistently fewer RN productive hours for medical-surgical nursing. CONCLUSIONS/IMPLICATIONS: For-profit hospitals and systems behaved differently in the healthcare market environment of the late 1990s. Select nonprofit systems were also using significantly less RN staffing. Other findings support the implication that as technology sophistication increases, there will be a need for increased RN hours to manage the advanced technology. This runs counter to the argument that increasing technology will decrease the need for RN hours. Finally, as discharges go up, the need for RN hours increases.

California↗
PubMed2005

Job satisfaction in relation to change to all-RN staffing.

BACKGROUND: A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost. AIM: The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff. METHODS: Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years. RESULT: The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.

Adaptation, Psychological↗
PubMed2006

Feeling the squeeze.

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Personnel Downsizing↗