Explore the vast range of titles available.

Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.

Background: In a qualitative study, medical-surgical and intensive care staff nurses reported that they did not complete a significant amount of nursing care on regular basis. Thus, it was determined that a quantitative tool was needed to measure the amount and type of missed nursing care and the reasons for missing care. Objective: The authors report the results of a psychometric evaluation of this tool (The Missed Nursing Care Survey [MISSCARE Survey]) to measure missed nursing care (part A) and the reasons for missed nursing care (part B). Study Methods: Two studies were conducted—study 1 (n = 459) and study 2 (n = 639). A sample of staff nurses was drawn from 35 medical-surgical, rehabilitation, and intensive care patient units in 4 acute care hospitals. Results: Acceptability was high, with 85% of the respondents answering all items on the survey. Factor analysis with Varimax rotation resulted in a 3-factor solution for part 2 (communication, labor resources, and material resources). Cronbach α values ranged from 0.64 to 0.86. Confirmatory factor analysis demonstrated a good fit of the data. Using a contrasting group approach, a comparison of nurse's perceptions of missed care on intensive care units versus rehabilitation units resulted, as hypothesized, in a significantly lower amount of missed care on intensive care units. Pearson correlation coefficient on a test-retest of the same subjects yielded a value of 0.87 on part A and 0.86 on part B. Conclusion: Although further validation of the MISSCARE Survey is needed, current evidence demonstrates that the tool meets stringent psychometric standards.

Organizational knowledge of nurse turnover costs is important, but gathering these data frequently may not always be feasible in today's fast-paced and complex healthcare environment. The author presents a method to inflation adjust baseline nurse turnover costs using the Consumer Price Index. This approach allows nurse executives to gain current knowledge of organizational nurse turnover costs when primary data collection is not practical and to determine costs and potential savings if nurse retention investments are made.

OBJECTIVE:Identify purposes and decision factors of the nurse-patient assignment process. BACKGROUND:Nurse-patient assignments can positively impact patient, nurse, and environmental outcomes. METHODS:This was an exploratory study involving interviews with 14 charge nurses from 11 different nursing units in 1 community hospital. RESULTS:Charge nurses identified 14 purposes and 17 decision factors of the nurse-patient assignment process. CONCLUSIONS:The nurse-patient assignment is a complex process driven by the patient, nurse, and environment. Further study is needed to identify factors linked to patient safety, nurse, and environmental outcomes.

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention.

Objective: To develop and examine the reliability and validity of a new instrument, the nurse-nurse collaboration (NNC) scale. Background: Nurse-nurse collaboration (NNC) is recommended to reduce medical errors and improve patient care and nurses' job satisfaction. While instruments are available to measure nurse-physician collaboration, an instrument to measure NNC was not available in the literature. Because collaboration is necessary for optimal patient care, a valid and reliable instrument would make it possible to measure the level of collaboration among nurses. Methods: A comprehensive literature review was conducted to develop a definition and define relevant domains of NNC and identify instruments with acceptable psychometrics that included items measuring NNC. Instrument items to develop the Nurse-Nurse Collaboration Scale (NNC Scale) were adapted from previously published tools or developed based on domains identified in the literature. Five domains were identified: problem solving, communication, coordination, shared process, and professionalism. Psychometric testing of the NNC Scale included pilot testing for content and construct validity and field testing among 76 staff nurses working in 4 ICUs in a large tertiary-care academic medical center in the northeast United States. Psychometric tests assessing reliability and convergent validity correlations were conducted. Results: The overall Cronbach α for the scale was .89. Convergent validity correlations, however, were low to moderate, indicating minimal shared variance among the subscales. Therefore, the instrument did not measure a global concept but rather 5 separate domains of collaboration. Internal consistency testing of the 5 subscales produced acceptable results ranging from .66 to .91. Conclusion: The NNC Scale demonstrated acceptable reliability and validity for measuring the level of NNC in intensive care nurses. Further psychometric testing and a factor analysis with a larger-sample, more diverse groups of nurses are necessary to further characterize the generalizability of the NNC Scale.

The literature confirms that much confusion exists regarding the terms quality improvement (QI), evidence-based practice (EBP), and research. A multifaceted approach was used to provide clarity regarding these three equally important concepts. First, the authors present a synthesis of the literature that discusses differences between QI, EBP, and research. Second, the authors introduce a newly created comparative table that synthesizes current literature and showcases differences between QI, EBP, and research. Finally, the authors highlight uses of the comparative table within multiple settings.

Objective To measure nursing workload and timely completion of essential tasks in relation to the staffing levels recommended by the British Association of Perinatal Medicine (BAPM) in Staffordshire, Shropshire and Black CountryNewborn Network. Methods A prospective observational study was conducted measuring the time taken by selected nurses to undertake the necessary tasks for babies receiving different levels of care in the Network's six constituent neonatal units. An independent observer was used. The unit and individual's workload was evaluated against BAPM standards. Delays in essential predetermined tasks were recorded. The impact on quantity of care given and on the number of delayed tasks were compared between those with the recommended workload or less and those overstretched. Results Between October 2008 and February 2009, 89 nurses were observed caring for 244 neonates over 534 h. 54% of nursing shifts failed to meet BAPM standards. Nurses with workload greater than the BAPM-recommended levels demonstrated a 28% decrease in median time spent on clinical care per baby. 92 (17%) essential tasks were delayed >1 h or not done. Delays/omissions were more likely when BAPM standards were not met (53% vs 40%, p=0.049). In nursing observations without delays/omissions, accommodating for adequate nursing breaks and working in the same area, nurses could cater for no more than 1.2, 1.5 and 2.7 babies in intensive care, high dependency care and special care, respectively. Conclusion Understaffing leads to measurable problems including delays to essential treatment and reduced clinical care. BAPM standards are not aspirational and should be regarded as a minimum. Further research on optimising nursing care efficiency with limited nursing resources is necessary.

Objective: The purpose was to examine the psychometric properties of the Revised Professional Practice Environment (RPPE) scale. Background: Despite renewed focus on studying health professionals' practice environments, there are still few reliable and valid instruments available to assist nurse administrators in decision making. Methods: A psychometric evaluation using a random-sample cross-validation procedure (calibration sample [CS], n = 775; validation sample [VS], n = 775) was undertaken. Results: Cronbach α internal consistency reliability of the total score (r = 0.93 [CS] and 0.92 [VS]), resulting subscale scores (r range: 0.80-0.87 [CS], 0.81-0.88 [VS]), and principal components analyses with Varimax rotation and Kaiser normalization (8 components, 59.2% variance [CS], 59.7% [VS]) produced almost identical results in both samples. Conclusions: The multidimensional RPPE is a psychometrically sound measure of 8 components of the professional practice environment in the acute care setting and sufficiently reliable and valid for use as independent subscales in healthcare research.

Analyze the number and the relevance of references retrieved from CINAHL, MEDLINE, and EMBASE to perform a nursing systematic review. A search strategy for the review topic was designed according to thesaurus terms. The study analyzes (1) references with abstract, (2) overlap between databases, (3) reference relevance, (4) relevance agreement between experts, and (5) reference accessibility. Bibliographic search retrieved 232 references: 16% (37) in CINAHL, 68% (157) in MEDLINE, and 16% (38) in EMBASE. Of these, 72% (164) were references retrieved with an abstract: 14% (23) in CINAHL, 70% (115) in MEDLINE, and 16% (26) in EMBASE. Overlap was observed in 2% (5) of the references. Relevance assessment reduced the number of references to 43 (19%): 12 (34.3%) in CINAHL, 31 (19.7%) in MEDLINE, and none in EMBASE ( Z = −1.97; P = .048). Agreement between experts achieved a maximum Cohen's κ of 0.76 ( P < .005). References identified in CINAHL were the most difficult to obtain (χ 2 = 3.9; df = 1; P = .048). To perform a quality bibliographic search for a systematic review on nursing topics, CINAHL and MEDLINE are essential databases for consultation to maximize the accuracy of the search.