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This study evaluates by comet assay the induction of early DNA damage in healthcare workers of an oncology hospital regularly handling antineoplastic drug mixtures. The aim was to identify a suitable biomarker of DNA damage by exposure to low levels of such drugs. We studied 12 day hospital nurses and 13 oncology ward nurses who performed up to 300 and up to 35 drug administrations per week, respectively, and five pharmacy employees who regularly prepared mixtures of antineoplastic agents. Thirty healthy subjects were selected as controls. For exposure evaluation, we performed environmental monitoring of 5-fluorouracil, cytarabine, gemcitabine, cyclophosphamide, and ifosfamide in selected work areas of pharmacy and day hospital units and biological monitoring of urine for the 5-fluorouracile metabolite, alpha-fluoro-beta-alanine. We evaluated early DNA damage in lymphocytes and exfoliated buccal cells by comet assay measuring tail moment (TM) parameter that indirectly indicates the presence of DNA damage. Environmental monitoring detected cyclophosphamide, 5-fluorouracil and ifosfamide, with higher levels of contamination in day hospital unit. The biological monitoring measured detectable levels of alpha-fluoro-beta-alanine only in three nurses. Comet assay showed an increase on exfoliated buccal cells, even if not statistically significant, of mean TM with respect to controls in day hospital nurses (43.2 vs. 28.6, respectively) while ward nurses and pharmacy technicians did not show differences. Comet assay performed on lymphocytes did not show appreciable differences between exposed and controls. The employment of the sensitive comet assay, which is able to detect early the effects of a recent exposure to genotoxic substances, allowed us to find a slight DNA damage, only on exfoliated buccal cells of day hospital nurses, the group handling the highest amount of drugs during the administration process. This finding suggests that comet assay on exfoliated buccal cells could represent a useful tool to evaluate early and still repairable genotoxic effects of exposure to antineoplastic drug mixtures and then contribute to the improvement of the hospital safety practices.

In the past three decades, the shortage of nurses willing to work in hospitals has been a persistent challenge in the United States. Hiring supplemental registered nurses-nurses on short-term contracts obtained through an external staffing agency-has been common to fill gaps in nurse staffing. But there has been insufficient evidence about supplemental nurse workforce trends to inform workforce policy. To address this concern, we compared qualifications and characteristics of supplemental nurses with those of permanent nurses during 1984-2008. The two groups shared similar education levels in terms of possessing a baccalaureate or higher degree. Supplemental nurses were somewhat less experienced than permanent nurses, averaging fifteen years of experience in 2008 compared to eighteen years for permanent nurses. The supplemental nurse workforce was more diverse racially and ethnically and more likely to be male than the permanent nurse workforce. These data show that employing supplemental nurses could help meet the challenges of an aging nursing workforce, the projected future shortage of nurses, and an increasingly diverse US population. [PUBLICATION ABSTRACT]

Objective: To examine the difference in perceptions of empowerment between nurses who were nationally certified and those who were not. Background: Nurses are encouraged to obtain certification in their specialty. The focus of most nursing research on certification has been on motivation to acquire certification and perceived benefits of certification. Research related to empowerment indicates that access to empowerment structures results in achievement and success. Methods: This descriptive comparative study used the Conditions of Work Effectiveness II Questionnaire to measure registered nurses' perceptions of empowerment. Certification status was recorded on the demographic section of the questionnaire. Results: Significant differences were noted in empowerment scores for certified and noncertified nurses as measured by the Conditions of Work Effectiveness II Questionnaire. Findings suggest that nurses who are certified have higher perceptions of empowerment. Certification may increase nurses' perceptions of empowerment and therefore improve work effectiveness. Conclusion: Certified nurses in this study had increased access to job-related power and opportunity structures. Certification provides recognition of the nurses' knowledge and expertise in the specialty area which in turn is empowering. Organizations that support and recognize this achievement may experience improved turnover and retention rates.

Objectives: To examine the phenomenon of job stages, particularly entry, mastery, and disengagement; to identify predictors of each stage; and to determine when disengagement occurs among nurses. Summary Background Data: Job or career stages have been conceptualized as an aspect of growth and development and also career growth and change. Graham identified job stages of entry, mastery, and disengagement and theorized that stages are related to time on the job, skill development, and attitudes. They are levels of identification of the self and ego with the job environment. Studies on burnout as well as hardiness were also examined because of their possible relations with job stages. Methods: This descriptive survey queried 412 RNs, selected by random sample from three hospitals, to determine their job stage. Demographic characteristics, role, years as a nurse, years in this hospital, years in this job, and job satisfaction, productivity, and organizational commitment were also measured. Data analyses provided frequencies and percentages, and logistic regression was performed to identify predictors of each job stage. Results: Forty-eight (13%) nurses reported being in the entry stage; 224 (62%) nurses were in mastery. Mastery was predicted by several variables, including U.S. education (negative) and organizational commitment (positive). Eighty-seven (24%) nurses reported being in disengagement, and this was predicted by years in this job and negatively predicted by organizational commitment. Conclusions: Strategic planning for mastery and avoidance of disengagement were discussed, and implications for administrators and the profession were presented.

Objective: A salaried Differentiated Pay Structure (DPS) model based on the work of Dr. Virginia Cleland was tested on two units. The project objectives were to: 1) create a budget-neutral compensation distinction for different competencies and educational levels; 2) evaluate the effect of the new salaried model on unit costs and pay; 3) determine the effect of the DPS model on job satisfaction, organizational commitment, and anticipated turnover; and 4) assess the impact of professional commitment, professional practice climate, perception of staffing adequacy, and dispositional optimism on job satisfaction, organizational commitment, and anticipated turnover. Background: Although there has been longstanding interest in salaried models and reward methodologies, there is a dearth of systematic research associated with specific compensation models. Methods: A quasi-experimental, non-equivalent control group design was used to examine the effects of the DPS model. Results: Findings demonstrated that nurses were paid more under the DPS model, and that they were paid for more hours than they actually worked (N = 68). No difference in job satisfaction was found between experimental and control groups. For all nurses (N = 232) dispositional optimism was associated with all job satisfaction subscales except pay. Organizational commitment, professional commitment, professional practice climate, and staffing adequacy were also correlated with job satisfaction, perceptions of care quality and anticipated turnover. Older nurses who had worked longer in nursing, and who had more tenure were less satisfied with their coworkers and care quality. Conclusion: Further longitudinal research with larger experimental samples is required in order to fully understand the effects of the DPS model in nursing.

Since the early 1970s, clinical ladder programs have been a method of defining, recognizing, and rewarding nursing practice. As clinical practice in an institution grows and evolves, so must the program that supports the development of the practitioner. An in-depth evaluation of one clinical ladder program was conducted to determine if it was reflective of current practice. The authors discuss the method of evaluation, findings, and the revised program.