Little nurses set pattern

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In outpatient and inpatient psychiatric settings there is a relationship between job satisfaction and client satisfaction; this result has not been supported for acute care hospitals and does not hold for outcomes other than client satisfaction. In addition to needing more research to further support or clarify some of the tentative findings indicated above, research is needed to fill the gaps in the state of the science. Some of the gaps in our current empirical knowledge include:. Whether satisfied staff in acute care give better care, resulting in improved client outcomes.

Whether there is a relationship between professional practice environments and patient outcomes other than mortality. Whether there is a connection between staffing mix and client outcomes of health status. What the interaction is between productivity and quality care and the main effect and interactive effect of these variables on client outcomes. What the influence of leadership is on the productivity and quality of nursing care.

A number of methodological problems and issues in research involving the investigation of nursing's effect on client outcomes were identified at the invitational conference. Only those that directly relate to the impact of nursing on client outcomes and the measurement of those outcomes are addressed in this paper.

These issues tend to categorize into three areas: The first issue under the area of sampling involves the sample size of research projects that examine nursing interventions that are unit based. These interventions include practice patterns, staffing mix, collaboration, and a number of other aspects of the work environment.

Since the environment in which nurses deliver care is often determined by the unit or the hospital in which they practice, the unit of analysis for most of these studies is not at the individual level. In general, the cost to implement a practice model requires a smaller sample size than would normally be desired when the sampling unit is the work group. A further cost factor has to do with the expense of collecting data in a number of sites or on a number of units.

Since some data must be collected at the individual level and aggregated to the unit e. Such information is normally collected and reported by hospitals. This approach results in outcome measures with a high degree of variability that are unit based from a limited number of units and a subsequent reduction in power.

Under such conditions, it is extremely difficult to find statistical significance. It is quite likely that this effect explains the inconsistent findings in the research on nursing's impact on mortality rates. The same may be true for other measures of client outcomes such as untoward hospital incidents and nosocomial infections. The good news about these measures is they are rare events; the bad news is that nursing's effect cannot be shown unless, like mortality data, the information is included in large databases to which researchers have access.

Nursing Staff in Hospitals and Nursing Homes: Is It Adequate?

A further result of small sample sizes is the resultant inability to use sophisticated statistical procedures that consider the multivariate nature of nursing practice and the complexity of factors that lead to positive client outcomes. In the Arizona study we were limited, primarily, to the most basic inferential statistics. When we were able to use individual data and, thus, increased our sample size, we found highly significant results. Also, when we examined patterns of response we had important findings—they may not be statistically significant but they are clear patterns that result from the use of more complex statistical techniques.

A second issue with sampling has to do with the number of patients who are ineligible to participate in the research for a variety of reasons.

Quality of Care, Organizational Variables, and Nurse Staffing

This problem is exemplified in the descriptive New York study Study 5. For this project, individual patients were interviewed. The potential sample was approximately 4, Of these, subjects refused to be part of the study and were ineligible. These may be the patients who are most sensitive to quantity and quality of nursing care.

However, when individual patient responses are required, these data are never collected e. In addition, patients are lost to studies for a variety of reasons and those reasons may, again, be critical in determining outcomes. The need to identify nurse-sensitive patient outcomes has been discussed in a number of settings with both clinicians, managers, and researchers. Although this need is critical, there remains a concurrent need to continue to use more traditional outcome measures e.

These client outcomes are recognized by consumers and other providers as being important in examining patient welfare. It must be recognized, however, that large sample sizes will be needed to increase the sensitivity of these measures and the measures must be readily available in large data sets to which researchers have access. When nurse-sensitive outcome measures are discussed, usually they are considered to be those that relate to specific patient problems or conditions.

For macrolevel research as described above, other outcomes must be identified. These outcomes need to be applicable across settings and conditions, and they must be reflective of the pattern of nursing care delivered. In order to be useful such outcomes must also be easy to measure on large numbers of patients, and when aggregated to the unit or hospital level they must have validity and reliability at that level.

The issue of aggregation has been examined recently and criteria for examining reliability and validity have been described Verran et al. Existing and ongoing work, such as that by the researchers in the San Francisco study, may provide a model for the development of such outcome measures. Their item instrument is clinically feasible, reliable, and valid with predictive power.

We need more of these measures that are applicable to a wide variety of clients, including the family of a client, and that can be used across units, hospitals, and settings. Such measures could eventually be included in databases and if used in a number of research projects will allow comparability. Currently, an expert panel of the American Academy of Nursing is beginning work on the identification of a set of these outcomes. What may be needed is to expand this work into a nationally supported nursing Patient Outcomes Research Team similar to those established for specific patient conditions through the Agency for Health Care Policy and Research.

A further issue in the area of sensitivity has to do with the timing of outcome measurement. Research that examines outcomes at one point in time, such as discharge, will probably not see significant results. In today's health care environment, positive outcomes usually occur in the community a significant period of time after the client leaves the hospital. In order to show the effect of nursing on outcomes, longitudinal studies need to be conducted. Hospital effects probably don't occur while the client is in the hospital.

It is after they are home for a while that they realize they don't know how to care for themselves or that they know a variety of techniques to relieve pain or discomfort. In association with this timing issue is the need to examine timing expectancies. There is an ideal outcome level to be achieved and there are benchmarks along the trajectory toward that achievement that need to be identified.

The third area of concern with researching the relationship of nursing to patient outcomes has to do with the consistency of outcomes measurement. Definitions of terms need to be very specific in order to compare findings across studies. With the complexity of nursing processes and small sample sizes, the only way firm conclusions can be drawn is by synthesizing the results from several research projects. One way to establish this specificity is to establish standardized nursing vocabularies for outcomes. These are not medical vocabularies—they are nursing oriented. We have some consistent work on a vocabulary for nursing problems and one for nursing interventions.

A group of researchers at the University of Iowa is also working on a taxonomy for outcomes. These taxonomies or categorization schemes are less meaningful, however, if the variables are not included in national databases. Nursing information on practice, staffing patterns, problems, interventions, and outcomes need to be incorporated into health care systems information. A national effort needs to be mounted to establish standardized vocabularies, incorporate them into databases, and encourage research using such systems.

This paper has been presented in four sections. The first reported on six current research projects examining the interrelationship of staff, organizational, and client outcome variables. Second, a review of literature from to on the effect of nursing care on general client outcomes was presented. From these two approaches, the linkages and gaps in our current knowledge about the effects of nursing care on client outcomes on a macrolevel were identified. Finally, methodological issues with research in this field were discussed.

These issues were organized into the three categories of sampling, sensitivity of measures, and consistency of measures.

Little Nurse

View in own window. So there is recognition of the fact that not one but several types of nurses are needed in the life of the country. Nurse Goodnow's words serve well as an introduction to a consideration of professional nursing education today and tomorrow, with their emphasis on the country's long-standing need for different kinds of nurses and on the importance to differentiated practice of different levels of formal education.

This paper will summarize within a historical context how the existing programs of study, from associate degree through postdoctoral training, singly and collectively strive to meet the demand for professional nursing within the United States.

Because nursing as a practice profession exists at the interface between the service sector and academia, the current state of affairs will then be analyzed in terms of the forces shaping both health care delivery and higher education. Existing at the interface between these two major social institutions affords nursing both advantages and disadvantages, which will be articulated. The major challenges ahead for professional nursing education will then be summarized with an emphasis at the end on the importance of addressing fundamentals. Although the opinions expressed are those of the author, a number of nurses responded with helpful comments to a very detailed outline of the paper.

See the "Author's Note" section at the end for a full listing of respondents. To understand the present, one must always have some sense of the past. The first "modern" school of nursing was founded in by Florence Nightingale at St. Thomas Hospital in London. A little more than a decade later, the first schools in the United States to build on her curriculum and philosophy i. Hospital diploma schools were a boon to their institutions, since student nurses provided most of needed patient care as inexpensive apprentices.

The demanding working conditions soon contributed to a shortage of student applicants. In an attempt to de-emphasize apprenticeship training, nursing schools began to be affiliated with academic institutions. The earliest university-based nursing education took place at Howard University, Teachers College of Columbia University, Johns Hopkins University, what is now known as the University of Texas at Galveston, Rush Medical College in Chicago, and the University of Minnesota, which in became the first university to have an official school of nursing.

By , nursing schools reported having college affiliations Goodnow, In , Sigma Theta Tau, nursing's honor society, was founded at Indiana University with the expectation that the baccalaureate degree was to be required for entry into professional practice; this has yet, however, to become the agreed-upon norm for the field. The s saw the formation of two committees—the Committee on the Study of Nursing Education and the Committee on the Grading of Nursing Schools —that issued reports on themes that would concern nursing for the remainder of the twentieth century: The s were a period when hospitals expanded and private duty nursing declined, as the sick were unable to pay for home care because of the economic depression.

Two reports in the s were to sound once again the theme of the need for standardized nursing education. The Brown Report , considered to be "the nursing equivalent of the Flexner Report in medicine" Friss, , p. That same year, the Committee on the Function of Nursing recommended upgrading standards for both the licensed practical nurse LPN and the registered nurse RN , the former with an associate degree and the latter with a bachelor's of science in nursing BSN degree.

Programs offering ADNs have largely replaced diploma programs in the last four decades see Table 1 , but they became another means of acquiring the RN rather than the LPN Deloughery, ; Murphy, ; Fondiller, Entry into professional nursing practice has been further complicated by the development of generic master's and doctoral programs on the grounds that undergraduate education is foundational to truly professional practice, just as it is for dentistry, law, and medicine Dolan et al.

For example, the first generic nursing doctorate ND was started at Case Western Reserve University in , and there are now three such programs Watson and Phillips, Graduate education for nurses, however, first took the form of additional preparation in the functional areas of education and administration as nurse leaders prepared for academic or supervisory roles.

The first master's degree was awarded by Teachers College of Columbia University in the s, and that institution also took the lead in doctoral education a decade later. The establishment of programs to develop advanced clinical skills occurred later. By , Yale University Graduate School offered a master's of science in mental health this program moved to the School of Nursing in In , Hildegard Peplau founded at Rutgers one of the first master's programs to prepare clinical nurse specialists. The first nurse practitioner program was started a decade later by Loretta Ford at the University of Colorado.

Three phases of doctoral education have been distinguished Grace, ; Murphy, ; Hart, Before , the emphasis was on functional role preparation, because nurses largely needed the EdD degree to develop the baccalaureate and higher education programs that began to be established during those years. In the s, the importance of the PhD for research training gained favor as nurses sought degrees in other disciplines so as to apply that learning in developing the scientific base of their profession.

Since the s, the emphasis has largely been on research training within nursing. That agency is organized to promote study of three general areas: Nursing in is a heterogeneous field; it covers the full spectrum of academic degrees from the associate degree through postdoctoral training. See Table 2 for an overview of graduations from nursing programs in the last academic year for which full data exist, — Seventy-one percent of the undergraduate degrees awarded that year were at the ADN level; if anything, "the proportion of new entrants into nursing that come from baccalaureate programs has declined" in recent years Friss, , p.

Of the 1,, employed nurses in March out of about 2. The traditional academic ladder for nurses begins with basic preparation at the undergraduate level—with a distinction between more technical preparation with the 2-year ADN and more professional preparation with the 4-year BSN—then presupposes advanced preparation in a specialty area at the master's level.

At the doctoral level, the emphasis is on in-depth study of some specific problems within the specialty area for the purpose of expanding the field's knowledge base. The purpose of postdoctoral training is to enable new doctorally prepared nurses to set in motion a program of research. See Figure 1 for an overview of nursing education pathways.

Existing programs have encouraged entry into the profession at various points, transitions from one academic level to the next, acceleration when career goals are clear, the acquisition of dual degrees as appropriate, and considerable experimentation. Professional nursing can be both criticized for its seemingly uncontrolled diversity and lauded for its innovative career ladder. Traditionally, such diversity has been regarded as antithetical to being a profession, since one of the characteristics of a profession was thought to be one entry point.

There is a growing opinion, however, that such diversity can be an asset if the practice at each level is differentiated in terms of education, experience, and demonstrated competence Pew Health Professions Commission, ; Conway-Welch, That is a very big IF.

Historically, many employers have not encouraged differentiated practice according to type of education, ostensibly because both ADN and BSN graduates, as well as generic master's and doctoral students, sit for the same licensure exam to become an RN. What is more, ADN graduates tend to score somewhat higher on the examination largely for two reasons: The lack of differentiation in the examination has emboldened employers to compress salaries accordingly.

Economic returns for BSN education "are modest at best, and well below the national averages for other professions" Lowry, , p. Efforts are under way by the National Council of State Boards of Nursing to create a second level of licensure that would evaluate the complex decision making, community health, and management skills of BSN graduates, but widespread implementation has not yet occurred.

Nurses themselves have contributed to the lack of differentiated practice. Generic baccalaureate BSN — A program of instruction that admits students with no previous nursing education and requires at least four but not more than five academic years of full-time-equivalent college academic work, the completion of which results in a bachelor of science in nursing. Registered nurse RN to BSN —A program that admits registered nurses with associate degrees or diplomas in nursing and awards a baccalaureate degree in nursing.

BSN for nonnursing college graduates— A program that admits students with baccalaureate degrees and with no previous nursing education and, at completion, awards a baccalaureate degree in nursing. RN to BSN external degree baccalaureate — A degree awarded by transcript evaluation, academically acceptable cognitive and performance examinations, or both, without residency and classroom attendance requirements. Master of Science in Nursing MSN — A program of instruction that admits students with baccalaureate degrees in nursing and, at completion, awards a master of science in nursing.

RN to MSN— A program that admits registered nurses without a baccalaureate degree in nursing and awards a master's degree in nursing. MSN for nonnursing college graduates— A program that admits students with baccalaureate degrees and with no previous nursing education and, at completion, awards a master's degree in nursing. MSN for nurses with nonnursing college degrees— A program that admits registered nurses with nonnursing baccalaureate degrees and, at completion, awards a master's degree in nursing.

Generic Nursing Doctorate ND — A generic doctoral program with a clinical focus primarily designed for baccalaureate-prepared college graduates with no nursing experience. Doctorate— A program of instruction requiring at least three academic years of full-time-equivalent academic work beyond the baccalaureate in nursing, the completion of which results in a doctoral degree that is either a doctorate of nursing science DNS, DNSc, or DSN or the doctor of philosophy degree PhD.

Postdoctorate— A program environment for multidisciplinary research training involving more than one unit of a university and a recruitment plan that will attract the most highly qualified candidates individuals must have received a doctoral degree from throughout the nation. In such a program environment the nursing unit has the ability to demonstrate that graduates of the program remain active in research. These program definitions are based on the typology used by the American Association of Colleges of Nursing in their annual institutional data survey.

Graduates of ADN programs, who are on average more mature and experienced at graduation the mean age was This tension between undergraduate programs is further exacerbated by all of the tensions between community colleges and universities. To the extent that different kinds of RNs are educated in different educational systems, there is little opportunity for learning how to work together. Matters have been further complicated by the fact that ADN graduates are regarded by the public at large, and especially by many a state legislature, as the success story of community colleges because of their speedy access to a relatively well-paid field.

Graduates of BSN programs, in contrast, are regarded as requiring an expensive undergraduate education by universities, which tend to equate professional education with graduate education. Legislators would resist efforts to limit the production of ADN graduates, while some universities may countenance the elimination of BSN programs as has happened, for example, in the University of California system.

The more that RN production is relegated to ADN programs, the more nursing is seen solely in vocational terms by the public, including career counselors, rather than as a career choice for the best and brightest. Nursing is so equated in the public mind with doing procedures and giving medications that nurses who manage complex systems and conduct research are viewed by many as not being ''real" nurses.

What has frequently been confused in ADN versus BSN discussions is the question of whether one is working at the bottom or the top of one's scope of practice.

While the ADN and the BSN recipient may look relatively comparable technically and interpersonally at graduation, their progress from novice to competent practitioner, and on to expert, will not be comparable Conway, The liberal education that is considered foundational to the development of critical thinking, decision making, and independent judgment in the BSN graduate is likely to facilitate the acquisition of the imaginal and systems skills required of advanced practice Koerner, Considerable efforts are under way to articulate a model for differentiated nursing practice; Table 3 provides a schematic synthesis of current thinking based on the recent AACN-AONE Task Force on Differentiated Nursing Practice and the work of Davis and Burnard as well as that of Koerner It should be noted that a characteristic of recent consensus development in this area has been giving up the technical versus professional distinctions of previous ADN-BSN debates, because of the pejorative implications in characterizing ADN graduates as not professional, in favor of distinguishing between practice in structured and unstructured environments.

Celebrating 40 years of ADN education, Simmons noted that that degree is no longer considered to be "terminal" in nature, but a pathway for career and educational mobility. Nursing education must move to an interconnected system of distinct educational levels with differentiated outcomes Fagin and Lynaugh, ; Hanner et al. The need to address these issues is crucial, because too many ADN graduates and too few BSN and higher degree nurses are being produced relative to future needs Aiken and Salmon, As health care delivery systems become increasingly primary care oriented and boundary spanning, the roles in which nurses will be needed will require more professional judgment and clinical autonomy Clifford, Expectations regarding educational level and competencies for advanced practice nursing roles are also in need of some clarification.

The American Association of Colleges of Nursing has taken the position that all advanced practice nurses APN should hold a graduate degree in nursing and be certified, and that the American Board of Nursing Specialties should serve as the umbrella board to assist member-certifying bodies adopt professional and educational standards for the evaluation and certification of APNs.

The effectiveness of this level of nurse has been documented Office of Technology Assessment, ; Safriet, ; APNs provide needed services with consumer satisfaction, demonstrable effectiveness, and significant cost savings Brooten et al. The term APN is used, however, to refer to a number of roles—clinical nurse specialists, nurse practitioners, certified nurse midwives, and nurse anesthetists.

Nurse practitioners have a history of providing primary health care services, while clinical nurse specialists have traditionally worked with less educated nurses to solve complex care problems, although psychiatric clinical nurse specialists and those majoring in community health or gerontology have also provided considerable first contact care.

There is substantial debate as to whether the clinical nurse specialist role, with its systems orientation, should merge with the nurse practitioner role, with its emphasis on delivering primary care, so that the public will be less confused by different titles Fenton and Brykczynski, ; Page and Arena, At the doctoral level, the debate centers on whether the research focus of PhD programs should supplant the clinical focus of professional-degree programs e.

Most of the original DNS programs were as research minded as any PhD program; the decision to establish a DNS program rather than a PhD program was often a political decision rather than an academic decision Downs, Professional-degree programs were more numerous when graduate schools were not very welcoming and took the attitude that a doctorally prepared nurse was an oxymoron.

As the quality of nursing research became established, so, too, did PhD programs in nursing. There is, however, some renewed interest in professional-degree programs as a means of preparing clinical leaders capable of the evaluation research that is needed for a quickly changing health care delivery system Starck et al. All of the emphasis within nursing education on the spectrum of academic degrees has had the unintended consequence that continuing education CE has received comparatively short shrift.

Many states do not have mandatory CE requirements for maintaining RN licensure. This state of affairs is particularly problematic because of the knowledge explosion and the many forces dramatically reshaping health care delivery. As with other professions, learning in nursing must be a lifelong enterprise that cannot stop with the awarding of a degree IOM, Health care delivery is changing dramatically, with the drive toward cost effectiveness leading to: These trends and their work force implications have been chronicled in a number of publications and reports Pew Health Professions Commission, , ; de Tornyay, ; Bureau of Health Professions, ; AAMC, ; Fineberg et al.

Professional nursing is, therefore, experiencing paradigm shifts. See Table 4 for an overview of some major changes as care moves away from traditional conceptualizations to expanded ones. Most nurses are still hospital based, but a shift is taking place away from nursing at the bedside to nursing at the patient's side wherever s he may be.

In the future, nurses must be able to span boundaries in providing continuity of care, particularly as case managers. Heretofore nursing, like medicine, has been organized to manage diseases and illness episodes, but henceforth emphasis will be placed on disease prevention and health promotion as cost containment measures. This means a renewed interest in compressing morbidity and facilitating quality of life, as opposed to focusing largely on limiting mortality. Instead of the military metaphor of health, with its view of the patient's body as a battlefield and the physician as captain of the ship, the ecologic metaphor offers the promise of "halfway technology," more concern about wastefulness, and a community orientation Annas, It should be noted, however, that the market metaphor with its language of "covered lives," market share, vertical integration, and customer satisfaction may be an intermediary step in reframing the debate.

Traditionally, nurses have been expected to meet as many of a patient's needs as possible. Those unbounded expectations are being superseded by the notion that needs should be triaged in terms of available resources, and that there should be fewer nursing imperatives—e. Nursing has been equated with providing care, but care as a one-to-one relationship will not be as large a component of professional nursing in the future because the RN is increasingly expected to direct the care provided by others Hines et al.

These changes are prompted, in part, because all-RN staff models of care are giving way to so-called partner models of care, with the RN skill mix dropping from 76 to percent to 52 to 79 percent in some settings Smeltzer et al. The in-process component of nursing will be less emphasized than what is actually achieved by way of outcomes, particularly cost-effective outcomes. Where the nurse has traditionally supported the physician as the primary care provider, there will be increasing emphasis on the nurse, particularly the APN, as a primary care provider, which means that responsibility must be balanced with corresponding authority e.

Up until now, the emphasis has been on discipline-specific education and practice, but this is shifting to become more interdisciplinary as cost-effective care requires all health care providers to avoid duplication of efforts and make full use of the best, least expensive care giver according to need. Such differentiated practice will replace the notion that the physician is the health care provider of choice for all situations.

Collectively, these shifts make it impossible to promise job security to any nurse, because of the extent to which institutions and systems are being reconfigured.

27 Cutest Stuff For Nurses

In place of job security, nurses need to take comfort from the career opportunities that will continue to hold for individuals who are skilled, as they are, in health promotion, boundary spanning, and clinical decision making. Nurses will continue to be in demand with the graying of America and the move toward community-centered practice, with its emphasis on a broad range of practice sites—schools, day care and senior centers, outpatient clinics, shelters, workplaces, homes, shopping malls, and church basements.

Computer literacy will become more important as technologies are developed to connect care givers in remote sites to information and assessment systems. The outcomes orientation of health care will also increase the demand for competencies like those of nurses who collect and analyze data to evaluate their own effectiveness and that of their institutions Oermann, b.

A return to community-centered care also requires that health care professionals "look like" the communities served; this means taking steps to recruit minority faculty and students in numbers proportionate to their representation in the area Morris and Wykle, , and to expand the number of men in the profession. Higher education is changing almost as fundamentally as health care delivery systems and in the same general direction toward greater accountability at a time of restricted taxpayer support. In the name of cost effectiveness, there have been a number of changes: These shifts have been chronicled in a number of publications Lynton and Elman, ; Shulman, ; Rice, ; El-Khawas, ; Brand, ; Magrath, The traditional university activities of teaching, research, and service are being rethought.

See Table 5 for an overview of some major changes as these activities are reconceptualized. The emphasis has shifted away from teaching to learning, with a concomitant new regard for the teacher as "guide by side" rather than "sage on stage. This moves the educational goal away from degree acquisition toward the development of a portfolio of competencies that can be described to prospective employers.

Outcomes have replaced the curriculum as the preoccupation of pedagogical attention. Furthermore, all of these activities are less and less place bound as the advent of new technologies and distance learning techniques make the "virtual university" possible. Thanks to Boyer's landmark work , scholarship is no longer narrowly defined to include only the scholarship of discovery i.

Where once the emphasis was solely on the investigator's interests, the expectation increasingly is that faculty research should be congruent with the campus mission. The product of that research should not only be scholarly publications but also contributions to the public good, which means that the private sector may be more interested in supporting some efforts with entrepreneurial possibilities.

Where service was once undervalued and discouraged, the opposite is increasingly the case. Indeed, there has been renewed interest in the concept of service learning. When the emphasis is on applying professional expertise for the public's well-being, these activities can even be conceptualized as a possible profit center for the university. Most professional schools are beginning to explore practice plans, contracts with local agencies, and continuing education for professionals and the public alike as possible new revenue streams.

Like the health care delivery system, higher education is increasingly sensitive to community need, focused on performance-based outcome measures, and concerned about differentiated faculty roles with a concomitant reliance on some mix in expertise. Novelty Bone Ballpoint Pen. Check out these fun bone pens. And as an extra bonus, reviewers say they write surprisingly well and the rubber makes them easy to grip. If you use pencils though and love plants, you might find these pretty cool. These super high quality No.

When your pencil is too short to use, just plant your used-up pencil to get any of these herbs: This Littmann nursing stethoscope aside from coming in this cute shade of pink is a great buy. The Prestige heart stethoscope like the Littmann above comes with some impressive customer reviews.

Another plus of this particular model is the heart. It comes at a really great low price and the sound quality is good. Unlike regular stethoscopes that might frighten little kids, this stethoscope is a lot of fun with seven cute interchangable animals. Sphygmomanometer — Love and Believe. If you want the complete package, check out this kit. It comes with a sphygmomanometer, a stethoscope, and a really cute container to place everything in. Stethoscope Cover — Happy Puppies.

This stethoscope cover has a multi-use design. You can use the pocket to carry small nursing stuffs like pens and alcohol prep packets.

Study Data And Methods

Reviewers say these covers are a good fit and the patterns look even better in real. Beginning in fiscal year , hospitals will face reductions in reimbursement if they do not meet national benchmarks on the two global measures of care on the Hospital Consumer Assessment of Healthcare Providers and Systems survey used in this study. Nurse working conditions, including shift length, is one area related to these benchmarks that we believe is readily amenable to change. The current literature cites twelve-hour shifts as a way to recruit and retain nurses because it is the preferred shift length among nurses.

But we also found that the nurses who worked shifts of 12—13 hours were more likely to intend to leave the job than nurses who worked shorter shifts, contrary to what the literature suggests. One possible explanation for the findings is that nurses underestimate the impact of working long shifts because the idea of working three days a week instead of five seems appealing. Working longer but fewer shifts may also attract nurses who work a second job.

However, the strain of those three long work days and the rest and recovery time needed may offset any perceived benefit, if our survey results are any indication. Our results suggest that similar policies for nurses—perhaps restricting the number of consecutive hours worked—should be considered by accrediting bodies, such as the Joint Commission. Shift lengths could also become reportable evidence for magnet recognition by the American Nurses Credentialing Center, which denotes nursing excellence in hospitals.

The Joint Commission recommended nine evidence-based actions, including assessment of off-shift hours and consecutive shifts worked, and the inclusion of staff in the design of work schedules to reduce risk for fatigue. At the state level, boards of nursing should consider whether restrictions on nurse shift length and voluntary overtime are advisable. This idea has been raised in the past, but it has been met with emphatic pushback from nurses who wish to maintain the status quo. Hospitals that do not require overtime but are short staffed may also face quality-of-care issues. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institute for Occupational Safety and Health.

Although survey data from four states showed that four out of five nurses were satisfied with scheduling practices at their hospital, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction. The authors observe that policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted.

Stimpfel holds a doctorate in nursing from the University of Pennsylvania. Sloane is an adjunct professor at the University of Pennsylvania School of Nursing. Douglas Sloane is a sociologist and adjunct professor at the University of Pennsylvania School of Nursing. He is also assistant director, social science analyst, and supervisory statistician at the Government Accountability Office, in Washington, D.

Aiken is the Claire M. Linda Aiken is the Claire M. She has a doctorate in sociology from the University of Texas at Austin and is a member of the editorial board of Health Affairs. National Center for Biotechnology Information , U. Author manuscript; available in PMC Nov 1. Amy Witkoski Stimpfel , Douglas M. Sloane , and Linda H. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Health Aff Millwood.

See other articles in PMC that cite the published article. Abstract Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the well-being of nurses. Open in a separate window. Is it time to pull the plug on hour shifts?: Safe staffing saves lives. ANA; [cited Oct 10]. A study examining the impact of hour shifts on critical care staff.

Twelve-hour shift on ITU: The working hours of hospital staff nurses and patient safety. Health Aff Millwood ; 23 4: Work schedule, needle use, and needlestick injuries among registered nurses. Infect Control Hosp Epidemiol. Nurse working conditions and patient safety outcomes. Comparison of nurse, system and quality patient care outcomes in 8-hour and hour shifts.

Am J Crit Care. Maslach C, Jackson SE. The measurement of experienced burnout. Advances in understanding and predicting nurse turnover. Res Sociol Health Care. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Centers for Medicare and Medicaid Services; [cited Oct 10]. Nurse burnout and patient satisfaction. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.

To access the Appendix, click on the Appendix link in the box to the right of the article online. Maslach Burnout Inventory manual. Consulting Psychologists Press; Effects of hospital care environment on patient mortality and nurse outcomes. Health Aff Millwood ; 30 2:

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