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This article describes four key principles from Targeted Reading Instruction (TRI, formerly called Targeted Reading Intervention), an evidence-based early reading intervention and professional development program. Focused on accelerating the growth of students not yet meeting grade-level expectations, one-on-one 15-minute daily TRI lessons engage students in developing phonemic awareness, phonics knowledge, decoding, fluency, vocabulary, and beginning reading comprehension. Four key principles guide TRI, which can be applied to classroom reading instruction. First, all work is done in the context of real words and connected text, placing meaning at the heart of instruction. Second, lessons keep it moving, as they follow a consistent structure, use activities to achieve multiple objectives, and make use of all available resources. Third, TRI teachers let the student do the work, engaging students in productive struggle. Fourth, explicit teaching of skills such as blending provides students with unique strategies to become confident independent readers.

ObjectiveTo evaluate staffing conditions, patient outcomes, quality of care, patient safety and nurse job outcomes in British Columbia (BC), Canada hospitals.DesignCross-sectional study of 58 hospitals in BC with surveys of nurses and independent measures of patient outcomes.Setting58 hospitals in BC.Participants6685 hospital-based nurses working in a direct patient care role.ExposuresHospital-wide and unit-specific patient-to-nurse staffing ratios derived from registered nurse reports of how many patients and how many nurses were on their unit during their last shift worked.Main outcomes and measuresObjective patient outcome measures included the Hospital Standardized Mortality Ratio (HSMR) and 30-day Readmission Rate, from 2022 to 2023 Canadian Institute for Health Information data. Nurses4All@BC provided data from 2024 using validated items on multiple measures (eg, nurse burnout, missed health breaks, intentions to leave, quality and safety measures such as culture of patient safety, quality of nursing care, missed nursing care).ResultsBurnout (59.4%), missed health breaks (41.7%), job dissatisfaction (36.0%), intentions to leave (19.3%) and patient outcomes (HSMR mean 95.4, median 96.0, range 26–180; readmission rate mean 10.0%, median 9.5%, range 7.9%–13.8%) were high and varied across hospitals. 68.3% of nurses reported there were not enough staff, and 77.3% reported their workloads were unsafe for patients. 60.6% of nurses gave their hospital an unfavourable patient safety rating. More patients per nurse were associated with poorer hospital mortality and readmission rates, poorer job outcomes for nurses, more adverse events for patients, less favourable ratings of quality of care and patient safety, more missed nursing care and poorer ratings of staffing adequacy and management.ConclusionsGiven the variability in staffing, quality and patient outcomes across BC hospitals, the implementation of a minimum nurse-to-patient ratio policy has the potential to improve patient care safety and retention of nurses.

abstract The US is experiencing a shortage of primary care providers, which could be reduced by the addition of nurse practitioners. However, the ability to increase the supply of nurse practitioners is limited by a shortage of clinical preceptors. The Affordable Care Act's Graduate Nurse Education Demonstration provided federal funding to offset the clinical training costs of advanced practice nurses. We used data from the American Association of Colleges of Nursing from academic years 2005-06 through 2017-18 to determine whether the demonstration was associated with increased nurse practitioner enrollment and graduation growth. The demonstration was associated with a significant increase in nurse practitioner enrollments and graduations. A promising model of organizing and implementing funding for graduate nursing education nationally was identified. Findings suggest that modernizing Medicare payments for nursing education to support nurse practitioner clinical training costs is a promising option for increasing primary care providers.

Nurse managers are central to hospital operations, yet little is known about how organizational factors, such as Magnet Recognition by the American Nurses Credentialing Center (ANCC), shape their assessments of the work environment, care quality, and safety. This study examined whether Magnet status is associated with nurse managers' assessments of these domains. This cross-sectional study used data from the 2024 Penn Nurses4All Survey, the 2023 American Hospital Association Annual Survey, and the ANCC's list of Magnet-recognized organizations. The sample included 1362 nurse managers from 771 hospitals across 10 U.S. states (450 in 186 Magnet hospitals and 912 in 585 non-Magnet hospitals). Outcomes included managers' assessments of the work environment, nursing care quality, patient safety, and hospital recommendation. Approximate balancing weights were applied to adjust for hospital- and manager-level covariates, and weighted linear probability models estimated average treatment effects. Magnet managers were more likely to hold graduate degrees and to work in large, teaching, and not-for-profit hospitals. Compared with non-Magnet managers, they were 9 percentage points more likely to rate the work environment as excellent or good (  = 0.09, 95% CI: 0.04-0.16) and to \"definitely\" recommend their hospital as a workplace (  = 0.09, 95% CI: 0.02-0.16); 7 percentage points more likely to rate nursing care quality as excellent or good (  = 0.07, 95% CI: 0.04-0.14); 12 percentage points more likely to assign an excellent or good patient safety grade (  = 0.12, 95% CI: 0.06-0.19); and 16 percentage points more likely to recommend their hospital to family and friends (  = 0.16, 95% CI: 0.08-0.24). Magnet status was associated with more favorable assessments of the work environment, quality, and safety among nurse managers. These findings suggest that Magnet structures may strengthen organizational environment and culture across multiple levels of the nursing workforce.

Background Hospital patient-to-nurse staffing ratios are associated with quality outcomes in adult patient populations but little is known about how these factors affect paediatric care. We examined the relationship between staffing ratios and all-cause readmission (within 14 days, 15–30 days) among children admitted for common medical and surgical conditions. Methods We conducted an observational cross-sectional study of readmissions of children in 225 hospitals by linking nurse surveys, inpatient discharge data and information from the American Hospital Association Annual Survey. Registered Nurses (N=14 194) providing direct patient care in study hospitals (N=225) and children hospitalised for common conditions (N=90 459) were included. Results Each one patient increase in a hospital's average paediatric staffing ratio increased a medical child's odds of readmission within 15–30 days by a factor of 1.11, or by 11% (95% CI 1.02 to 1.20) and a surgical child's likelihood of readmission within 15–30 days by a factor of 1.48, or by 48% (95% CI 1.27 to 1.73). Children treated in hospitals with paediatric staffing ratios of 1 : 4 or less were significantly less likely to be readmitted within 15–30 days. There were no significant effects of nurse staffing ratios on readmissions within 14 days. Discussion Children with common conditions treated in hospitals in which nurses care for fewer patients each are significantly less likely to experience readmission between 15 and 30 days after discharge. Lower patient-to-nurse ratios hold promise for preventing unnecessary hospital readmissions for children through more effective predischarge monitoring of patient conditions, improved discharge preparation and enhanced quality improvement success.

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.

As the permafrost region warms, its large organic carbon pool will be increasingly vulnerable to decomposition, combustion, and hydrologic export. Models predict that some portion of this release will be offset by increased production of Arctic and boreal biomass; however, the lack of robust estimates of net carbon balance increases the risk of further overshooting international emissions targets. Precise empirical or model-based assessments of the critical factors driving carbon balance are unlikely in the near future, so to address this gap, we present estimates from 98 permafrost-region experts of the response of biomass, wildfire, and hydrologic carbon flux to climate change. Results suggest that contrary to model projections, total permafrost-region biomass could decrease due to water stress and disturbance, factors that are not adequately incorporated in current models. Assessments indicate that end-of-the-century organic carbon release from Arctic rivers and collapsing coastlines could increase by 75% while carbon loss via burning could increase four-fold. Experts identified water balance, shifts in vegetation community, and permafrost degradation as the key sources of uncertainty in predicting future system response. In combination with previous findings, results suggest the permafrost region will become a carbon source to the atmosphere by 2100 regardless of warming scenario but that 65%-85% of permafrost carbon release can still be avoided if human emissions are actively reduced.