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Weaver SH, Hessels AJ, Paliwal M, Wurmser TA. From dusk to dawn: A healthy work environment for nurses working night shift. Nurs Manag (Harrow) 2023; 54:18-27. [PMID: 36998184 DOI: 10.1097/01.numa.0000921912.36370.fb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Susan H Weaver
- Susan H. Weaver is a nurse scientist at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J., and the New Jersey Collaborating Center for Nursing in Newark, N.J. Amanda J. Hessels is an assistant professor at Columbia University School of Nursing in New York, N.Y., and a nurse scientist at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J. Mani Paliwal is a senior biostatistician at Hackensack Meridian Health , Institute for Evidence Based Care in Edison, N.J. Theresa A. Wurmser is the vice president of nursing research, grants and academic affairs at Hackensack Meridian Health Ann May Center for Nursing in Neptune, N.J., the dean of the Georgian Court-Hackensack Meridian Health School of Nursing in Lakewood, N.J., and a member of the Nursing Management Editorial Board
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Weaver SH, de Cordova PB, Vitale TR, Hargwood P, Salmond S. Experiences and perceptions of nurses working night shift: a qualitative systematic review. JBI Evid Synth 2023; 21:33-97. [PMID: 35975311 DOI: 10.11124/jbies-21-00472] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this review was to examine the available evidence on the experiences and perceptions of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting. INTRODUCTION Nurses are required for around-the-clock patient care. Night shift nurses can experience detrimental effects because of their work hours, which disrupt their normal circadian rhythm. Understanding nurses' experiences and perceptions when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' experiences and perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved nurse and patient outcomes. INCLUSION CRITERIA This review included qualitative studies focused on the experiences and perceptions of registered nurses and licensed practical nurses who work the night shift or rotate between day and night shift. METHODS This review followed the JBI methodology for systematic reviews of qualitative evidence. The methodology used was consistent with the a priori protocol. Studies included in this review were those published in full text, English, and between 1983 (when the seminal work on hospitals that attract and retain nurses was published) and February 2021, when the search was completed. The main databases searched for published and unpublished studies included MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science.From the search, two reviewers independently screened the studies against the inclusion criteria, and then papers selected for inclusion were assessed for methodological quality. Qualitative data were extracted from the included papers independently by the four reviewers. Results from each reviewer were discussed and clarified to reach agreement. The extracted findings were pooled and examined for shared meaning, coded, and grouped into categories. Common categories were grouped into meta-synthesis to produce a comprehensive set of synthesized findings. The final synthesized findings were graded using the ConQual approach to determine the level of confidence (trust) users may have in the value of the synthesized findings. RESULTS Thirty-four papers, representing 33 studies, met the criteria for inclusion. The studies were conducted in 11 countries across six continents, with a total of 601 participants. From these, a total of 220 findings were extracted and combined to form 11 categories based on similarity in meaning, and three syntheses were derived: i) The "Other" Shift: the distinctiveness of night nursing; ii) Juggling sleep and all aspects of life when working nights; and iii) Existing in the Twilight Zone: battling the negative impact of sleep deprivation consumes nurses who strive to keep patients, self, and others safe. CONCLUSIONS The major conclusions from this review are the uniqueness of working the night shift and the sleep deprivation of night nurses. Organizational strategies and support are needed for those working this shift, which will enhance nurse and patient safety. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019135294.
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Affiliation(s)
- Susan H Weaver
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, NJ, USA.,School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Pamela B de Cordova
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Tracy R Vitale
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA
| | - Pamela Hargwood
- Robert Wood Johnson Library of the Health Sciences, Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Susan Salmond
- School of Nursing, Rutgers, the State University of New Jersey, Newark, NJ, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Nurses' experiences and preferences around shift patterns: A scoping review. PLoS One 2021; 16:e0256300. [PMID: 34398904 PMCID: PMC8367008 DOI: 10.1371/journal.pone.0256300] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature. Data sources Electronic databases (CINHAL, MEDLINE and Scopus) were searched to identify primary studies up to April 2021. Methods Papers reporting qualitative or quantitative studies exploring the subjective experience and/or preferences of nurses around shift patterns were considered, with no restrictions on methods, date or setting. Key study features were extracted including setting, design and results. Findings were organised thematically by key features of shift work. Results 30 relevant papers were published between 1993 and 2021. They contained mostly qualitative studies where nurses reflected on their experience and preferences around shift patterns. The studies reported on three major aspects of shift work: shift work per se (i.e. the mere fact of working shift), shift length, and time of shift. Across all three aspects of shift work, nurses strive to deliver high quality of care despite facing intense working conditions, experiencing physical and mental fatigue or exhaustion. Preference for or adaptation to a specific shift pattern is facilitated when nurses are consulted before its implementation or have a certain autonomy to self-roster. Days off work tend to mitigate the adverse effects of working (short, long, early or night) shifts. How shift work and patterns impact on experiences and preferences seems to also vary according to nurses’ personal characteristics and circumstances (e.g. age, caring responsibilities, years of experience). Conclusions Shift patterns are often organised in ways that are detrimental to nurses’ health and wellbeing, their job performance, and the patient care they provide. Further research should explore the extent to which nurses’ preferences are considered when choosing or being imposed shift work patterns. Research should also strive to better describe and address the constraints nurses face when it comes to choice around shift patterns.
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Weaver SH, de Cordova PB, Vitale TR, Salmond S. Experiences and perceptions of nurses working night shift: a qualitative systematic review protocol. JBI Evid Synth 2021; 18:1278-1284. [PMID: 32813375 DOI: 10.11124/jbisrir-d-19-00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this qualitative systematic review is to examine the available evidence on the experiences of nurses working the night shift within any specialty in the acute care, subacute, or long-term care setting. INTRODUCTION Nurses are required for round-the-clock patient care, and night shift nurses can experience detrimental effects as a result of their work hours. Understanding nurses' experiences when working night shift will facilitate the development of strategies to minimize the potential negative effects of working at night. In examining nurses' perceptions of working night shift, there is scope to explore how to improve night shift nurses' practice environment and job satisfaction, which will then translate to improved patient outcomes. INCLUSION CRITERIA This review will consider qualitative studies that include registered nurses and licensed practical nurses who work night shift or rotate between day and night shift. Night supervisors and advanced practice nurses will be excluded due to the potential for dissimilar experiences and resources within those groups. The search will be limited to studies published in English from 1983 to the present. METHODS The search strategy is designed to locate both published and unpublished qualitative studies by searching academic databases for published studies, gray literature, and hand searching reference lists. The study selection, critical appraisal, data extraction, and synthesis for this systematic review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019135294.
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Affiliation(s)
- Susan H Weaver
- Hackensack Meridian Health, Ann May Center for Nursing, Neptune, USA.,Rutgers, the State University of New Jersey, School of Nursing, Newark, USA
| | | | - Tracy R Vitale
- Rutgers, the State University of New Jersey, School of Nursing, Newark, USA
| | - Susan Salmond
- Rutgers, the State University of New Jersey, School of Nursing, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence
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Kushemererwa D, Davis J, Moyo N, Gilbert S, Gray R. The Association between Nursing Skill Mix and Mortality for Adult Medical and Surgical Patients: Protocol for a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228604. [PMID: 33228155 PMCID: PMC7699481 DOI: 10.3390/ijerph17228604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
Skill mix refers to the number and educational experience of nurses working in clinical settings. Authors have used several measures to determine the skill mix, which includes nurse-to-patient ratio and the proportion of baccalaureate-prepared nurses. Observational studies have tested the association between nursing skill mix and patient outcomes (mortality). To date, this body of research has not been subject to systematic review or meta-analysis. The aim of this study is to systematically review and meta-analyse observational and experimental research that tests the association between nursing skill mix and patient mortality in medical and surgical settings. We will search four key electronic databases—MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCOhost], and ProQuest Central (five databases)—from inception. Title, abstract, and full-text screening will be undertaken independently by at least two researchers using COVIDENCE review management software. We will include studies where the authors report an association between nursing skill mix and outcomes in adult medical and surgical inpatients. Extracted data from included studies will consist measures of nursing skill mix and inpatient mortality outcomes. A meta-analysis will be undertaken if there are at least two studies with similar designs, exposures, and outcomes. The findings will inform future research and workforce planning in health systems internationally.
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Gan I. A scoping review of the nursing workforce's changing demography: Supporting Baby-Boomer nurses. J Nurs Manag 2020; 28:1473-1480. [PMID: 32786163 DOI: 10.1111/jonm.13132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS This scoping review discusses two telecommuting options to advance scholarship regarding Baby-Boomer nurses' delayed retirement and to extend their contribution to bedside nursing. BACKGROUND Peer-reviewed studies published in the 15 years before COVID-19 indicate that Baby-Boomer nurses' retirement will increase the global nursing shortage. However, three international trends have affected Baby-Boomer nurses' decision to delay their retirement. EVALUATION This review observed the scoping review framework. KEY ISSUES COVID-19 further disrupts the current understanding of Baby-Boomer nurses' retirement as they recognize COVID-19's impact on health care systems and younger nurses. Technological advancements and the changing needs of health care delivery have made telecommuting a practical possibility. CONCLUSION Baby-Boomer nurses can leverage alternative work arrangements to meet their needs and to contribute to clinical practice through telecommuting. This approach extends Baby-Boomer nurses' careers and creates a resource for bedside nurses. IMPLICATIONS FOR NURSING MANAGEMENT Clinical experience matters at the bedside. Telecommuting maximizes the retention of Baby-Boomer nurses' clinical expertise to benefit patients and to socialize bedside nurses. Baby-Boomer nurses can contribute to patient monitoring as well as patient education and counselling through telehealth. They can also provide asynchronous and synchronous telementoring to bedside nurses.
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Affiliation(s)
- Ivan Gan
- Department of Arts & Communication, University of Houston-Downtown, Houston, TX, USA
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Li L, Hou Y, Kang F, Li S, Zhao J. General phenomenon and communication experience of physician and nurse in night shift communication: A qualitative study. J Nurs Manag 2020; 28:903-911. [PMID: 32255215 DOI: 10.1111/jonm.13018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
AIM This paper explored the general phenomenon and psychological experience of the special background communication in night shift medical staff and provides better reference for night shift communication between doctors and nurses. BACKGROUND Physician-nurse communication has always been an important agenda for health care work and an important concept in nursing theory. During night shifts, effective doctor and nurse communication can enhance mutual trust, provide timely and appropriate medical services to patients, reduce adverse events and enhance patient safety. DESIGN A qualitative study was conducted. METHODS Husserl's descriptive phenomenology method and semi-structured in-depth interviews were used to collect data from 8 nurses and 5 doctors. Colaizzi's method was used to analyse data using MAXQDA 12. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed (see Appendix S1). RESULTS Three themes were extracted after sorting out and refining: the need to achieve goals in night-time physician-nurse communication; obstacles in night-time physician-nurse communication; and relationship culture in night-time physician-nurse communication. CONCLUSION Attention should be paid to the particularity of night shift and efficiency of achieving the goal of communication between doctors and nurses on night shift, and the hidden obstacles behind communication between doctors and nurses. Managers should pay attention to the cultural construction of night shift communication in the system, form a good night shift communication process and regularly train doctors' and nurses' related communication skills. And they should also study relationship culture rationally to improve the communication efficiency of night shift. IMPLICATIONS FOR NURSING MANAGEMENT The experiences described in this study contribute to a better understanding of obstacles hidden behind night shift physician-nurse communication. This also provides valuable information to professional managers who develop good doctor-nurse relationship culture.
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Affiliation(s)
- Linbo Li
- Department of Mental Health, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongchao Hou
- Emergency Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Fengying Kang
- Resident Standardized Training Central, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Suping Li
- Department of Mental Health, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Zhao
- Department of Mental Health, The First Hospital of Shanxi Medical University, Taiyuan, China
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Gan I. Alternative work arrangements: Reshaping the future of nurses' workplace communication and relationships. Nurs Forum 2019; 54:227-231. [PMID: 30566243 DOI: 10.1111/nuf.12321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM This commentary advocates a research agenda for studying how alternative work arrangements (AWAs) affect nurse management and leadership. BACKGROUND AWAs mitigate burnout and the distributional imbalance of nurses. However, scholarship has shed limited light on how AWAs shape nurses' workplace communication and relationships. EVALUATION Peer-reviewed nursing and management scholarship. KEY ISSUE As healthcare systems in many countries move toward team-based care, communication becomes even more important for effective coordination and collaboration among healthcare team members. CONCLUSION Researchers should invest greater resources to understand the influence that AWAs have on different organizational settings as well as on the relational coordination among nurses and their managers. IMPLICATIONS FOR NURSING MANAGEMENT Because care delivery and workplace relations depend heavily upon effective collaboration, researchers must update scholarship on AWAs to inform nurses and their managers on how they may strategically and effectively adapt their communication to evolving work environments that undergo frequent changes in nursing staff and teams.
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Affiliation(s)
- Ivan Gan
- Department of Arts and Communication, University of Houston-Downtown, Houston, Texas
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Fossum M, Hewitt N, Weir-Phyland J, Keogh M, Stuart J, Fallon K, Bucknall T. Providing timely quality care after-hours: Perceptions of a hospital model of care. Collegian 2019. [DOI: 10.1016/j.colegn.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Arsenault Knudsen ÉN, Brzozowski SL, Steege LM. Measuring Work Demands in Hospital Nursing: A Feasibility Study. IISE Trans Occup Ergon Hum Factors 2018. [DOI: 10.1080/24725838.2018.1509910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Linsey M. Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Cunningham J, O'Toole T, White M, Wells JSG. Conceptualizing skill mix in nursing and health care: An analysis. J Nurs Manag 2018; 27:256-263. [PMID: 30238572 DOI: 10.1111/jonm.12673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper aims to unpack the concept of "skill mix" into its constituent parts to achieve a better understanding and reduce confusion associated with the term. BACKGROUND Skill mix is a topic that is widely debated and is foremost on the health policy agenda due to specific local pressures within international health services. At present, however, there is large variation in terms of what is understood by the concept of "skill mix" and there is a paucity of research that attempts to analyse this concept. EVALUATION Using Rodgers' evolutionary method of concept analysis, this paper provides an analysis of definitions of skill mix, its attributes and associated terms in the literature. KEY ISSUE Definitions of skill mix are often vague and ambiguous and may refer to one or more attributes of skill mix. CONCLUSION A lack of understanding of the concept can lead to an ad hoc interpretation of policy recommendations related to skill mix at local level. IMPLICATIONS FOR NURSING MANAGEMENT A better understanding of the concept of "skill mix" and its attributes can assist both policy makers and stakeholders, including nurse management, to ensure that the potential of skill mix is maximized.
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Affiliation(s)
- Jennifer Cunningham
- Lecturer in Mental Health Nursing, Department of Nursing and Health Care, Waterford Institute of Technology, Waterford, Ireland
| | - Thomas O'Toole
- Head of School of Business, Waterford Institute of Technology, Waterford, Ireland
| | - Mark White
- Director of Nursing and Midwifery Planning and Development Unit, HSE South, Kilkenny, Ireland
| | - John S G Wells
- Head of School of Health Sciences, Waterford Institute of Technology, Waterford, Ireland
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Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL. The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J Hosp Med 2017; 12:760-766. [PMID: 28914284 DOI: 10.12788/jhm.2815] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The presence of a "weekend effect" (increased mortality rate during Saturday and/or Sunday admissions) for hospitalized inpatients is uncertain. PURPOSE We performed a systematic review to examine the presence of a weekend effect on hospital inpatient mortality. DATA SOURCES PubMed, EMBASE, SCOPUS, and Cochrane databases (January 1966-April 2013) were utilized for our search. STUDY SELECTION We examined the mortality rate for hospital inpatients admitted during the weekend compared with those admitted during the workweek. To be included, the study had to provide discrete mortality data around the weekends (including holidays) versus weekdays, include patients who were admitted as inpatients over the weekend, and be published in English. DATA EXTRACTION The primary outcome was all-cause weekend versus weekday mortality with subgroup analysis by personnel staffing levels, rates and times to procedures rates and delays, or illness severity. DATA SYNTHESIS A total of 97 studies (N = 51,114,109 patients) were examined. Patients admitted on the weekends had a significantly higher overall mortality (relative risk, 1.19; 95% confidence interval, 1.14-1.23). With regard to the subgroup analyses, patients admitted on the weekends consistently had higher mortality than those admitted during the week, regardless of the levels of weekend/weekday differences in staffing, procedure rates and delays, and illness severity. CONCLUSIONS Hospital inpatients admitted during weekends may have a higher mortality rate compared with inpatients admitted during the weekdays.
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Affiliation(s)
- Lynn A Pauls
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Johnson-Paben
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John McGready
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie D Murphy
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
| | - Christopher L Wu
- Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
- Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland, USA
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Weaver SH, Lindgren TG. Getting safely through the shift: a qualitative exploration of the administrative supervisor role. J Nurs Manag 2017; 25:430-437. [DOI: 10.1111/jonm.12481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan H. Weaver
- Ann May Center for Nursing; Hackensack Meridian Health; Neptune USA
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Abstract
The administrative supervisor, who is the nurse manager present on the night and weekend shifts, can be found in hospitals throughout the United States. Yet, very little research has been published about this role on weekend and night shifts in acute care hospitals. The objective of this qualitative research study was to gain a better understanding of the administrative supervisor role. In-depth interviews with administrative supervisors were conducted at acute care hospitals in the mid-Atlantic region of the United States. Thematic analysis was used to reduce the data and identify codes and themes. Administrative supervisors experience and described their role within a "different" hospital world on weekends and at night. The administrative supervisors consistently stated that they oversee and are responsible for staffing and patient flow, crisis management, and management support for the staff. That administrative supervision is a challenging position for nurses is particularly evident as researchers seek to obtain a better understanding of how nurse leaders make a difference. This research delineates these different supervisor role responsibilities to provide a better understanding of management during the "off-shift." Nurse leaders can utilize this information to assist in justifying the need for this shift management role at their institutions.
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Khan A, Baird J, Rogers JE, Furtak SL, Williams KA, Allair B, Litterer KP, Sharma M, Smith A, Schuster MA, Landrigan CP. Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention. Acad Pediatr 2017; 17:389-402. [PMID: 28143793 PMCID: PMC5438159 DOI: 10.1016/j.acap.2017.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/13/2017] [Accepted: 01/22/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess parent and provider experience and shared understanding after a family-centered, multidisciplinary nighttime communication intervention (nurse-physician brief, family huddle, family update sheet). METHODS We performed a prospective intervention study at a children's hospital from May 2013 to October 2013 (preintervention period) and May 2014 to October 2014 (postintervention period). Participants included 464 parents, 176 nurses, and 52 resident physicians of 582 hospitalized 0- to 17-year-old patients. Pre- versus postintervention, we compared parent/provider top-box scores (eg, "excellent") for experience with communication across several domains; and level of agreement (shared understanding) between parent, nurse, and resident reports of patients' reason for admission, overnight medical plan, and overall medical plan, as rated independently by blinded clinician reviewers (agreement = 74.7%, kappa = .60). RESULTS Top-box parent experience improved for 1 of 4 domains: Experience and Communication With Nighttime Doctors (23.6% to 31.5%). Top-box provider experience improved for all 3 domains, including Communication and Shared Understanding With Families (resident rated, 16.5% to 35.1%; nurse rated, 32.2% to 37.9%) and Experience, Communication, and Shared Understanding With Other Providers (resident rated, 20.3% to 35.0%; nurse rated, 14.7% to 21.5%). Independently rated shared understanding remained unchanged for most domains but improved for parent-nurse composite shared understanding (summed agreement for reason for admission, overall plan, and overnight plan; 36.2% to 48.2%) and nurse-resident shared understanding regarding reason for admission (67.1% to 71.2%) and regarding overall medical plan (45.0% to 58.6%). All P <.05. CONCLUSIONS A family-centered, multidisciplinary nighttime communication intervention was associated with improvements in some, but not all, domains of parent/provider experience and shared understanding, particularly provider experience and nurse-family shared understanding. The intervention was promising but requires further refinement.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | | | - Jayne E. Rogers
- Department of Nursing, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Stephannie L. Furtak
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Kathryn A. Williams
- Clinical Research Center, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02215
| | - Brenda Allair
- Family Advisory Council, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Katherine P. Litterer
- Center for Families, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | | | - Alla Smith
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Christopher P. Landrigan
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA
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Henderson J, Willis E, Toffoli L, Hamilton P, Blackman I. The impact of rationing of health resources on capacity of Australian public sector nurses to deliver nursing care after-hours: a qualitative study. Nurs Inq 2016; 23:368-376. [PMID: 27548331 DOI: 10.1111/nin.12151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 11/26/2022]
Abstract
Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care.
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Affiliation(s)
- Julie Henderson
- School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Eileen Willis
- School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Luisa Toffoli
- School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Patricia Hamilton
- College of Nursing, Texas Women's University, Denton, Dallas, TX, USA
| | - Ian Blackman
- School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia
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Miller H, Goetzl L, Wing DA, Powers B, Rugarn O. Optimising daytime deliveries when inducing labour using prostaglandin vaginal inserts. J Matern Fetal Neonatal Med 2015; 29:517-22. [PMID: 25758619 PMCID: PMC4776722 DOI: 10.3109/14767058.2015.1011117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine induction start time(s) that would maximise daytime deliveries when using prostaglandin vaginal inserts. METHODS Women enrolled into the Phase III trial, EXPEDITE (clinical trial registration: NCT01127581), had labour induced with either a misoprostol or dinoprostone vaginal insert (MVI or DVI). A secondary analysis was conducted to determine the optimal start times for induction by identifying the 12-h period with the highest proportion of deliveries by parity and treatment. RESULTS Optimal start times for achieving daytime deliveries when using MVI appear to be 19:00 in nulliparae and 23:00 in multiparae. Applying these start times, the median time of onset of active labour would be approximately 08:30 for both parities and the median time of delivery would be the following day at approximately 16:30 for nulliparae and 12:00 (midday) for multiparae. Optimal start times when using DVI appear to be 07:00 for nulliparae and 23:00 for multiparae. Using these start times, the median time of onset of active labour would be the following day at approximately 04:00 and 11:50, and the median time of delivery would be approximately 13:40 and 16:10, respectively. CONCLUSIONS When optimising daytime deliveries, different times to initiate induction of labour may be appropriate depending on parity and the type of retrievable prostaglandin vaginal insert used.
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Affiliation(s)
- Hugh Miller
- a Watching Over Mothers & Babies Foundation , Tucson , AZ , USA
| | - Laura Goetzl
- b Department of Obstetrics, Gynecology and Reproductive Sciences , Temple University , Philadelphia , PA , USA
| | - Deborah A Wing
- c Department of Obstetrics and Gynecology , University of California , Irvine, Orange , CA , USA .,d Miller Children's and Women's Hospital , Long Beach , CA , USA
| | - Barbara Powers
- e Independent Consultant , Phoenixville , PA , USA , and
| | - Olof Rugarn
- f Ferring Pharmaceuticals , Copenhagen , Denmark
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